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|) Medical Library of E. F. WELLS, M.D. f 
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A Compact and Practical Handy-Book. 


EPIDEMIC CHOLERA: 


f 


ITS MISSION AND MYSTERY, HAUNTS AND 
HAVOCS, PATHOLOGY AND TREATMENT. 


. With Remarks on the Question of Contagion, the Influence of Fear, and 
Hurried and Delayed Interments. 


BY A FORMER SURGEON IN THE SERVICE OF THE 
HONORABLE EAST INDIA COMPANY. 


NEW YORK: 
Carterton, PustisHeR, 413 Broapway. 


M DCCC LXVI. 


Entered, according to Act of Congress, in the year 1866, by 
GEO. W. CARLETON, = 


In the Clerk's Office of the District Court of the United States for the 
Southern District of New York. 


Toe New York Printing ComMPANy, 
81, 83, and 85 Centre Street, 
New YorK. 


To 
FRED. LAW OLMSTED, ESQ, 


ARCHITECT-IN-CHIEF OF THE CENTRAL PARK, AND LATE 


GENERAL SECRETARY OF THE U. 8. SANI-. 
TARY COMMISSION, 


. Obese Pages are Dedicated 
IN RECOGNITION OF HIS 


SAGACIOUS, HONEST, AND LIBERAL BENEFICENCE. 


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CONTENTS. 


PAGE 
I.—The Mission and the Havocs of Cholera.......... 7 
II.—Symptoms of Cholera—Premonitory Stage and 
COQU ESO tare etmaier aie sha wtaca) acosbbcea in a0 os eat eee ki 
III.—Variations in the Symptoms........0...eceeuees 26 
EV =a TheiStage. Ob W6yOt 2 ci sce kena s tus uclte s sco sian 33 
V.—Recovery—True and Fallacious................. 38 
Vi.—Appearances on Dissection... ........eceneerces 41 
VIl.—Helps and Hints towards a Pathological Definition 46 
VIII.—Pathological Conclusions..... b Mansanaeets Agus cubits 54. 
1X.—Epidemic Cholera and Cholera Morbus—The Differ- 
CCE. i siaia gi aipiwiite dele shen ¢ ov carci asia » « sheaiers 62 
Poser lL POAUMOTIY « oue sin sin aes 6 stained aie do ov pie'ss.0 Mars g 94 66 
In the Premonitory Stage... 2.0... ee cece 71 
In the Stage of; Collapse sie... Sie ne vee os 76 
OUTITIG re reer Cah alate Me Cale’. Sales s «a hae & 78 
AMS TLeROtOliatns ete acide ate, «1s ok a 3 died suegigtss 84. 
Jo thesstare ol every co ys .un's +0 as s,s 0) "s 86 
Mi —16 Cholera Contagious) i acs os cs0.c tee oss ceca e's 88 
XII.—The Influence of Fear... ...cscces sc aces Fara woe 101 
XIII.—Hints to the Sanitary Boards................0.. 10m 
PSD Vise tO DORA ecaattstertels = tuitetals alate gine s'atce Scere @icees 108 
Talia er chats Mie ecbich din «151 altel aie mo @ on af ovals neato 109 
APPENDIX: 
Cholera—Its History and Localizing Causes......... 11] 


Cholera and Common Sense..... LE Ne catare a dieters 115 


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EPIDEMIC CHOLERA. 


I. 
THE MISSION AND THE HAVOCS OF CHOLERA. 


Epripemic CHoimra, like the Plague and the Yellow 
Fever, is a main branch of the Universal Sanitary 
Commission of Almighty God—armed with Herculean 
powers to turn a river of death through the Augean 
stables of the World’s filth and lewdness and drunk- 
enness and ignorance and waste; and in the name 
of the King of Terrors, to compel from purple and 
fine linen and sumptuous fare a trembling recognition. 
of their mortal brotherhood with nakedness and 
starvation and pitiful squalor. For, as Scott says, 
“the Beggar had no surgeon to dress, or ointment to 
mollify, or even a garment to hide his sores, so that 
the dogs, for very pity, came and licked them ”— 
but his name, Lazarus, signified God my Helper. So 
Epidemic Cholera is a famous scourer of consciences 
as well as sinks, a masterly whitewasher of hearts as 
well as sewers, a potential disinfectant of “shoddy” 
and “ petroleum” as well as garbage—moral as well 
as medical Inspector-General to the King of kings. 


8 THE MISSION AND THE HAVOCS OF CHOLERA. 


But it has had, in its time, some awfully heavy 
contracts on its hands, which, for the stubbornness, 
Stupidity, and stench to be removed, we can compare 
with no known anti-nuisance movement, unless, per- 
haps, a job of New York street-cleaning in the dog- 
days. 

For instance: in 1762, according to Lebegue de 
Presle, the Cholera, in a visitation to Upper Hin- 
dostan, removed a nuisance consisting of 30,000 
natives and 800 Europeans. 

From 1774 to 1781, it scoured the Coromandel 
Coast, and ‘at one period destroyed above 60,000 
people, from Cherigam to Pondicherry. As every- 
where else in the world, the Pariahs were its first 
and favorite victims. : 

In April, 1783, about a million and a half of de- 
votees had assembled on the banks of the Ganges at 
Hurdwar, to celebrate a religious festival of peculiar 
popularity. Upon this frantic herd the Cholera 
burst in fury, and literally “cleaned out” 20,000 
hysterical heathens in eight days. 

On the 19th of August, 1817, Dr. Robert Tytler, 
who practised medicine at Jessore, about a hundred 
miles north-east of Calcutta, was called to visit a 
Hindoo who had been attacked the night before 
with violent paims in his bowels, accompanied by 
purging and vomiting. Dr. Tytler found the man 
dying, and was about to report the case to the town 
authorities as one of poisoning, when he learned 
that, in the same part of the Bazaar, ten other 
natives had died with the same symptoms, and in 


THE MISSION AND THE HAVOCS OF CHOLERA. 9Q 


another Bazaar, seven more, and that the disease 
had attacked many persons in the street. This was 
Asiatic Cholera, and in two months it had swept off 
more than 10,000 of the inhabitants of Jessore. 
Such was the origin of the “new pestilence,” as it 
used to be called, which, after overrunning all parts 
of India, where it has prevailed endemically every 
year, and extending to Birmah, China, and Austra- 
lia, Arabia, Persia, Russia, and the heart of Europe, 
finally reached this Western Continent by way of 
Quebee and Montreal, in June, 1882, J essore has 
been styled ‘the cradle of the Cholera,” because it 
was not until its irruption there in 1817, that the 
disease attracted anxious attention in Europe. Be- 
sides, Cholera did not appear as an epidemic at Cal- 
cutta until September, 1817; and for the ten years 
preceding, not a single case had been treated at the 
general hospital for Europeans in that busy mart. 
But that year it raged throughout the “City of 
Palaces,” and 86,000 persons were attacked in the 
first three months of its visitation. It extended in 
almost every direction around Jessore, to the dis- 
tance of 250 miles, and it has been computed that at 
least 600,000 persons died of Cholera in thirty-two 
cities, in 1817. At some of the towns and military 
stations, the invasion was so sudden that the roads 
were covered with the dead and dying, who had not 
time to regain their tents or houses. Men mounted 
on horses were seen to fall from the saddle, unable 
to rise again. ‘The first week in November it 


broke out in the grand army under the command of 


10 THE MISSION AND THE HAVOCS OF CHOLERA. 


the Marquis of Hastings, composed of 10,000 English 
and 80,000 Sepoys, and encamped on the right bank 
of the Betoah. On the fifth and sixth days, the 
mortality became so great that despair seized the 
bravest. To the usual uproar and gayety of a camp, 
succeeded a mournful silence, only broken by the 
groans of the dyimg and the lamentations of the 
survivors. The principal roads and fields around 
the camp were strewed with the dead bodies of 
those who had thought to escape by flight. No ex- 
pressions can truly describe the spectacle of desola- 
tion which this army, but lately so brilliant, now 
presented. In twelve days, 9,000 men had died, 
and a still greater number had fled. Those who 
remained, overwhelmed by so frightful a disaster, 
disregarded the voice of their chief, and sought only 
to save their lives, or stun their fears by debauchery.” 
We recall here the dreadful revelries of Captain 
Dowling’s reckless verse—“ The Song of the Dying :” 


“There’s many a hand that’s shaking, 

There’s many a cheek that’s sunk; 

But soon, though our hearts are breaking, 
They'll burn with the wine we’ve drunk. 

So! stand to your glasses, steady ! 
"Tis here the revival lies; 

A cup to the dead already, 
And hurrah for the next that dies! 


“There’s a mist on the glass congealing, 
"Tis the hurricane’s fiery breath ; 
And thus does the warmth of feeling 
Turn ice in the grasp of Death. 


THE MISSION AND THE HAVOCS OF CHOLERA. 11 


So! stand to your glasses, steady ! 
For a moment the vapor flies, 

A cup to the dead already— 
Hurrah for the next that dies!” 


Happily the Marquis of Hastings marched his 
army across the Betoah, and pitched his camp on 
dry and elevated ground, where the disease soon 
subsided. ; 

In 1819, the pestilence advanced from Madras 
towards the south; all along the coast numerous 
towns which had escaped the preceding year were 
now desolated by a frightful mortality: Hardly 
fewer than 150,000 people died in the Presidency of 
Bombay in 1819, from Cholera alone. Entire vil- 
lages were depopulated, and so great was the panic, 
that the crews of many vessels, laden with cotton, 
deserted and fled in the night. At Bombay, nearly 
20,000 persons were attacked. Bankok, the capital 
of Siam, lost more than 40,000 of its inhabitants. 
As the people attributed the calamity to the influ- 
ence of an Evil Spirit, which, under the form of a 
fish, had sought refuge in the Gulf of Siam, the Sove- 
reign authority ordered the celebration of solemn 
religious rites on the coast, in order to exorcise the 
finny demon; but the gathering at one place of so 
dense a throng of human beings, redoubled the fury 
of the pestilence, and the mortality was frightful. 
The same year the island of Sumatra was devastated, 
and so terribly did the disease ravage the capital, 
that the King fled to the mouth of the river, where 


12 THE MISSION AND THE HAVOCS OF CHOLERA. 


he formed acamp. But the Angel of Death followed 
them thither; and before the year was out had 
flapped his black wings over forty degrees of latitude 
and fifty of longitude. 

In 1820 the Cholera inspired the inhabitants of 
Manilla with so wild a terror that they broke out 
in an insurrection, In which many Europeans and a 
great number of natives perished. 

In 1821 it appeared at*Jaggurnah on a missionary 
expedition. So furiously did it rage among the 
heathen during the annual monstrosities in honor 
of Juggernauth, that there were not left maniacs 
enough to drag the car of the idol around the temple, 
and that year not asingle devotee enjoyed the luxury 
of being crushed under its wheels. 

The same year the scourge invaded Bassora on, 
the Persian Gulf, and slew 17,000 out of a popula- 
tion of 60,000. Thence it passed to Bagdad, and 
destroyed one-third of the population. At Shiraz 
the mortality was awful; Batavia lost 17,000 inha- 
bitants, and the entire island of Java 102,000. The 
scourge traversed forty-three degrees of latitude and 
seventy of longitude, sweeping and garnishing the 
unclean places. 

In 1822 the progress of the pestilence was in the 
direction of Europe. The Prince Royal of Persia, 
having attacked the Turkish army, saw his own 
array, a few days after the victory, swept away by 
the epidemic. 

In 1823 the Omnipotent Scavenger swept the Bir- 
man Empire, and not even the name of the heir to 


THE MISSION AND THE HAVOCS OF CHOLERA. 13 


the crown, worn as an amulet around the neck, was 
awful enough to arrest its progress, or diminish the 
number of its victims. In China, also, the disease 
raged everywhere, “ in consequence of the innumera- 
ble canals,” and a population as the sands on the 
sea-shore. The Russian authorities urged the Man- 
darins to adopt preventive or preservative measures ; 
but the Mandarins (self-possessed philosophers !) 
replied that the deaths would allow more room in the 
world for those who survived ; and besides, that the 
Cholera chose its victims from among the filthy and 
the intemperate, and that no person of courage, who 
lived with moderation and cleanliness, would die of 
it. The Emperor, they declared, had said to his 
subjects, ‘‘ Do not believe that the disease is strong- 
er than yourselves. It only kills the scared people.” 
Sagacious Emperor! 

The same year the Cholera marched northward, 
as far as Orenbourg, on the confines of Asia and 
Kurope, where numerous caravans arrive yearly 
from China and Hindostan ; it also made its appear- 
ance on the eastern shores of the Mediterranean, 
and created a lively alarm in Europe. 

In 1825 the Cholera returned to Bombay, and 
compelled the authorities to build hospitals, and 
burn great quantities of wood, tar, and gunpow- 
der. 

In 1827 the epidemic again attacked Calcutta, and 
this time horses, cattle, elephants, swine, and dogs 
shared the fate of human pariahs. The Hindoos at- 
tributed the prolongation and universality of the 


14 THE MISSION AND THE HAVOCS OF CHOLERA, 


scourge to the anger of the God of the Cemeteries, 
provoked by the absence of human sacrifices. “ At 
Paleal, a Hindoo woman resolved to burn herself on 
the body of her husband, who had died of Cholera, 
but the Rajah refused to patronize, or even permit, 
the performance. ‘The widow, however, was urgent 
in her suit, and declared that the pestilence would 
cease in five days if she were allowed to sacrifice 
herself’ The Rajah yielded, and the woman 
burned—but it made no difference to the Cholera. 

In 1830 the epidemic prevailed all along the shores 
of the Caspian Sea, and on the 27th of July ap- 
peared at Tiflis, the capital of Georgia, nearly de- 
populating it by death and flight. Impatient of the 
limits within which it had hitherto been confined, it 
had, the year before, crossed the Ural Mountains, 
which separate Europe from Asia. On the 19th of 
July it reached Astrakhan, at the mouth of the 
Volga, and thence spread up that river, reaching 
Nischnei Novgorod about the last of August. On 
the 15th of September it appeared at Moscow, where 
it created a senseless panic, and 50,000 persons fled 
the city in a few days. The consternation was gen- 
eral throughout the Russian Empire, and the Czar 
offered a'reward of 25,000 roubles for the best dis- 
sertation on the nature, causes, prevention and cure 
of Cholera. A Council of Health was convened at 
Moscow, composed of physicians from Paris, Berlin, 
GOttingen, and other cities. 

In 1831 it appeared at St. Petersburg—on the 
26th of June—having previously visited Archangel, 


THE MISSION AND THE HAVOCS OF CHOLERA. 15 


Warsaw, Riga, Polangen, and Dantzic. The Czar 
retired in dismay from the imperial city, and sur- 
rounded himself and his court with a cordon mili- 
taire, permitting no approach from without. In 
May it broke out in Mecca, among the innumerable 
pugrims to the shrine, and “abated ” thousands upon 
thousands of the foulest of those pious nuisances, 
with whom “it isa point of religion that no pilgrim 
shall change his clothes during the whole period of 
his pilgrimage, and that each pilgrim shall sacrifice 
at least one sheep, and leave the skins and offal to 
rot under an Arabian sun.” 

Berlin was visited by the Cholera in the last week 
of August, and from the 1st of September to the 
middle of December, when it had nearly disappeared, 
the number of cases was 2,230, of which more than 
half died. On the 16th of August, the scourge en- 
tered Vienna from Hungary, in defiance of a double 
cordon, though the authorities refused to recognize 
its presence until the 15th of September, by which 
time it was raging with violence. It was remarked 
that, in Vienna, the Cholera destroyed more of the 
nobility and people of the higher classes than at 
any other time or place; and here, likewise, was a 
most extraordinary fatality among physicians and 
other attendants upon the sick. 

The Cholera also prevailed this year (1831) at 
Constantinople. The Turkish Government declined 
to establish quarantines, but distributed gratuitously, 
throughout the empire, small pamphlets giving a 
history of the disease, and the most approved me- 


16 THE MISSION AND THE HAVOCS OF CHOLERA. 


thods of prevention and treatment. Their good 
sense was rewarded with a mild visitation. 

“On the 26th of October, the Board of Health of 
Sunderland, in England, officially announced the 
presence of Cholera in that town. A few cases had 
been noticed in August, but it did not prevail epi- 
demically until the last of October.” On the 27th 
of January it appeared in Edinburgh, and soon 
afterwards reached London, where, contrary to all 
expectations, its ravages were inconsiderable. On the 
24th of March it appeared for the first time in Paris, 
where it prevailed with great severity ; and shortly 
afterwards broke out in Dublin. Thenit crossed the 
Atlantic, landed at Quebec on the 8th of June, was 
in Montreal by the 14th and New York by the 25th 
since when its marches and its operations have 
been traced, observed, and reported with such 
anxious interest, both in Europe and America, as to 
call for no recapitulation here. 


Hi. 
SYMPTOMS OF CHOLERA. 


Tue Diagnosis of Epidemic Cholera, especially in 
the stage of collapse, is, fortunately, as easy to ac- 
quire as the pronunciation of Italian. It has its 
peculiar features—its characteristic expressions, mo- 
tions, signs, and sounds—which are the same, to be 
readily recognised all the world over. One case 
may differ from another in certain modifications and 
“accidents ” proper to the individual, according to 
temperament, habits, and state of health, as one 
Chinaman differs from another in looks and ways; 
but there will be no mistaking the Cholera or the 
Chinaman in either subject; for there are the high 
cheek-bones, the flat nose, the pig-eyes, the perpe- 
tual cunning twinkle, and the “tail”’; and here are 
the listless, sunken eye, the corpse-like features, the 
appalled expression, the plaintive whine, the blue, 
brown, or lead-colored skin, the cold, clammy, 
*‘ doo’s-nose”’ feel, the rice-water evacuations, the 
cramps, the “dead ineat ” tongue, and the chilled 
breath. That physician would indeed be eminently — 
ignorant or stupid who should fail to recognize a 
case of Asiatic Cholera in the stage of OU oem 
Hydrophobia is not plainer. 

But let us imagine a case, and trace it from its 


18 SYMPTOMS OF CHOLERA. 


commencement to its close, which, since we shall 
“leave it to nature,” will surely be death; no man 
ever heard of an instance of true Cholera curing 
itself, after spasms, and the clammy blueness, and 
‘“‘ washer-woman’s fingers,” and that ominous sink- 
ing, had set in. Nature, appalled and paralyzed by 
the stunning stroke of the fierce Angel of Reform, 
seems to slink away and leave the field to him, retir- 
ing, like Achilles, to supineness and despair; and 
.only the hopeful, patient, and sagacious calls of 
Science can rouse her to arms again. 

We will suppose that the Cholera, having flanked 
all the quarantine defences, has entered New York, 
and that its presence has been honored by official 
recognition. You have a friend with Cholera on 
the brain—nervous, anxious, scared—the eyes of his 
imagination continually turned inward upon his 
stomach and bowels, with a morbid fascination suf- 
ficient, by its very magnetism, to conjure a “cramp” 
there. Perhaps he has been dyspeptic, subject to 
indigestions and troublesome alternations of consti- 
pation and looseness. Perhaps he has domestic or 
business anxieties, that keep his spirits depressed. 
Perhaps his occupation is unwholesome—confining, 
exposing, or overtasking him, invading his hours 
of natural and necessary rest. Perhaps he is an in- 
- temperate man, given to spells of excess, followed 
by corresponding spells of “shakes,” with loss of 
appetite and sleeplessness and vague alarms, and all 
the other reproachful shapes of nervous prostration. 
Perhaps, by habit or necessity, he is a keeper of 


SYMPTOMS OF CHOLERA. 19 


bad hours—out in the chilly and damp air of night ; 
a man, too, familiar with wet feet and irregular and 
hurried meals. Perhaps, on the other hand, he is a 
pampered, gouty gourmand—committing slow sui- 
cide with the entire catalogue of French crudities, 
and flourishing in the face of Providence, cucum- 
bers, radishes, and hard-boiled eggs. Perhaps—a 
hundred peradventures, all ending in the certainty 
that he is a ready-made case for Cholera, and that 
he is scared. 

Well, this cut-and-dried victim, who is neither 
filthy, nor lewd, nor naked, nor starved, nor house- 
less, nor squalid, but only respectably unfortunate, 
or a fool, “does not feel well this morning ”?—in 
fact his sensations are exceedingly queer, not to say 
alarming. ‘ Do you know anything about Cholera? 
and what are the premonitory symptoms?” And 
then he goes on to describe them to you with an 
unconscious accuracy, impressive as a diagnosis, and 
touching by its melancholy portent. 

For several days, he says, he has had a vague feel- 
ing of uneasiness, accompanied by a sense of heat 
and disorder in the stomach and bowels, with loose- 
ness—a simple feculent diarrhcea, with little or no 
griping, the “‘ movements” steadily increasing in 
frequency day by day. At first there were but 
three, yesterday there were a dozen. He has occa- 
sional nausea, with more and more lassitude and 
languor.. He is giddy, too, at times, and very weak, 
especially just after purging. ‘Has he headache?” 
Rarely, and never: much. But he has an empty, 


20 SYMPTOMS OF CHOLERA. 


hollow feeling, and this morning, at daybreak, he 
vomited thin, watery stuff, mixed.with a little bile, 
and some undigested food. ‘How did he pass the 
night?” Badly. ‘He shivered some, his stomach 
and bowels were distended, and he was calied to 
stool three or four times, passing a thin sort of 
whitish water, like whey, or the “ rice-water” that 
his Cholera-book—he has been reading “ Cholera- 
books,” you perceive—so often mentioned. There 
were starchy-looking flakes floating in it, with some 
bile at first, but that grew less. He was very rest- 
less, had some ringing in his ears, and a tingling 
sensation in his hands and feet, first in one and then 
the other, as if they were asleep; and once or twice 
his foot was cramped. You feel his pulse—per- 
haps it is somewhat accelerated and weaker than in 
health; you look at his tongue—not much altera- 
tion there—it is moist, and slightly furred; but he 
says his mouth is dry, and he feels thirsty. You 
observe particularly that his features are sharp, and 
that his countenance wears an apprehensive, anxious 
expression. You advise him to go straight to bed, 
and send for adoctor. But he doesn’t. Jones, who 
is also his friend, much “ bosomer” than you; 
Jones, who has all the common sense, and is such 
a practical, strong-headed fellow, you know; Jones, 
who never felt uncomfortable an hour in his life, 
and don’t believe in doctors and their nasty truck ; 
Jones says, ‘ Nonsense; youre only scared!” Half 
right, Jones! That sort of people are always 
half right. ‘ Keep yourself quiet, and don’t eat 


SYMPTOMS OF CHOLERA. 21 


anything—then your bowels will have nothing to 
purge about. Guess conundrums, and leave this 
little shake to nature, and you'll do.” Between 
Jones and nature, let us see what he comes to. 

An interval of twenty-four, or perhaps forty-eight 
hours, has elapsed before you see him again. Can 
this be the same man? Ah, Jones, what have you 
done, with your conundrums and your nature? 
The hand of death is on him? You read his doom 
in his cadaverous countenance ; in the livid circles 
around his mouth, and his dull, sunken eyes; in the 
sharp, contracted features; in the blue lips, and the 
leaden, brown, or even purple, face and neck— 
according to the shade of his complexion, and the 
intensity of the attack; in the wrinkled, sodden, 
‘¢washer-woman’s” fingers, from which the rings 
have dropped off; in the bluish pearl-whiteness of 
the nails; in the almost blackness of the lines 
tracing the larger superficial veins; in the labored, 
irregular, and broken respiration—“‘inspiration ap- 
pearing to be effected by an immense effort of the 
chest; while the nostrils, instead of expanding, col- 
lapse, and stop the ingress of the air, and expiration 
is hurried and convulsive.” 

You call him by his name, and he answers with 
a helpless, wild, terror-stricken stare. You read his 
doom in that; and that look, if you are a doctor, 
you will never forget; it is the very catastrophe 
of forlornness. You read his doom in his incessant 
tossing from side to side, and his agonizing travail 
and struggle for breath—the throes of a woman 


22 SYMPTOMS OF CHOLERA. 


in the fierce pangs of labor. You read it in the 
shrunken toes, in the spreading, ‘dead-body” dis- 
coloration of feet, and legs, and thighs, and arms, 
and presently of chest and abdomen also. You read 
it in the withered hand laid piteously, appealingly, 
on stomach and breast. You feel it in the pulse, 
small as a thread, and hardly vibrating, soon to be 
totally extinct. You feel it in the deadly coldness 
and clammy dampness of the skin; in the tongue, 
perhaps white and loaded, but always moist and 
flabby, and chilled, “like a bit of dead flesh ’—the 
*¢ dog’s-nose feel.” You hear it in the almost gone 
voice ; in the plaintive whisper of that eternal ‘ wa- 
ter, water, water!” in the occasional weak, suffering 
whine; in that dreadful low wail “which no man 
who has once heard it can ever forget—the lowest 
moan of the most wretched mendicant goes not to 
the heart more poignantly.” If he tries to speak, 
it is by only one word at a time; his lungs cannot 
retain air enough for even the shortest sentence; 
and oh, the weight and anguish at his heart; and 
oh, the fire in stomach, and bowels, and throat! 
Strange, too, that with skin so deadly cold, and 
almost insensible to the action of chemical cauteries, 
he should yet complain at times of feeling too warm, 
and offer to throw off the bed-clothes; his very 
sensations are beside themselves. If you could only 
feel him, you would surely thik he had been dead 
a day or two; and yet, from first to last, he has had 
nothing like a well-marked chill, only now and then 
a sort of nervous shivering. 


SYMPTOMS OF CHOLERA. yas 


The attendants tell you that after you saw him 
last, the purging became more and more frequent— 
abundant, sudden, and “shot out”? with force— 
nothing but watery stuff, Sir,—sometimes dirty, 
sometimes with flaky, starchy matter floating in it— 
but always like barley-water. Lvery time he was 
purged his pulse would sink, and he would have a 
spell of cramps in his feet and legs, and get bewil- 
dered, and stagger like a drunken man, or fall down 
like a helpless child. Since he grew so weak he has 
not purged so often or so much—‘“ seems like he 
hadn’t life enough in his body even for that.” The 
vomiting has not been in proportion to the diarrhea 
—not so frequent or sudden or abundant—and now 
it has quite ceased; what he did throw up was like 
the stools—barley-water or whey ; only once or twice 
it was quite green. eit 

‘* How did the spasms grow upon him, and in what 
form did they manifest themselves?” Well, first 
of all, there was the thrilling and tingling im the toes 
and fingers, as if they were asleep ; then a quivering, 
rather strange than painful—a “funny feeling,” he 
called it—in the hands and feet; then a sudden 
twitching and stiffening and twisting of toes and 
fingers which seemed to alarm him greatly ; he held 
up his deformed hands in a helpless, pitiful way, and 
cried. Next the calves of the legs, and the muscles 
of the arms and thighs and loins were drawn up in | 
excruciating knots—as if only particular sets of fibres 
were in spasm, and the tendons stood strongly out ; 
then, “the integuments of the abdomen were raised 


24 SYMPTOMS OF CHOLERA. 


in irregular folds, and the belly itself violently drawn 
backward toward the spine, the diaphragm upward 
and inward toward the chest ;” here, too, were hard- 
ness and constant pain, and the parts felt sore to the 
touch. But though the cramps (which were inva- 
riably increased on moving) were agonizing, there 
was no convulsion. 

No urine appeared now—the kidneys were already 
dead; no bile—the function of the liver was abolish- 
ed; he had ceased to expectorate—the salivary 
glands. were withered; and, touching climax! the 
fountain of his tears was dry: surrounded by all 
that is endearing and heart-rending, wrung with 
anguish, unnerved, undone—he could not even weep. 

But the end is upon him. Colder, colder! That 
horrible clammy, corpsy sweat, smelling of the vault, 
burst forth afresh ; his lips and cheeks puff out and 
flap, in expiration, “ with a white froth between them, 
asin apoplexy.” ‘The spasms have cramped his very 
vitals; his pulse is gone forever; fewer and fainter 
grow the broken heavings of his chest; if you could 
draw blood from him now, it would ooze drop by 
drop, black and sluggish, tarry and cold. Now there 
is a quivering among the tendons of his wrist, and 
his weary breast is almost still. His mind has re- 
mained clear through all the rack and agony, and he 
is conscious yet; yet he makes no sign—only a long, 
weary, convulsive sob, but no “rattle.” It is pain- 
lessness and sleep that the lovely Angel Death has 
brought him, and the most delicious moment of his 
life is—the last. 


SYMPTOMS OF CHOLERA. 25 


So that’s what “Common Sense” and “ unassisted 
Nature ” did for a case of Cholera Asphyxia. As for 
us, all that we can do for it is to see that the dead 
body is not buried alive. 

2 


IT. 
VARIATIONS IN THE SYMPTOMS. 


THE general features—what one may term the con- 
tour—of Cholera Asphyxia, that compendium of 
the prominent phenomena from which, in all latitudes, 
seasons, localities, and classes, the disease may be 
easily and certainly made out, being sharply defined 
and uniform, the same symptoms, nevertheless, vary 


infinitely in the degree of their intensity, “ according 


to circumstances” internal or external to the indivi- 
dual—from the simplest diarrheea, with little pain and 
no cramps, and no graver derangement of the circu- 
lation and temperature of the surface than occurs 
from the operation of an ordinary purgative, up to 
the overwhelming attack of a prostration so paralyz- 
ing that the person stricken has scarcely become 
sensible of pain when the secretions are suppressed 
and the heart’s action sinks suddenly. 

Sometimes the premonitory symptoms are pro- 
tracted, and the patient has a week or more of warn- 
ing, in the form of diarrhcea, uneasiness, and a sense 
of heat and “ thrill” in the stomach and bowels; in 
some cases, not diarrhea, but obstinate costiveness, 
prevails. Sometimes he “ falls dead in his tracks,” 
like the men in the army of the Marquis of Hastings. 
At Bellamy, in India, a tailor was attacked while at 


ee. | 


VARIATIONS IN THE SYMPTOMS. 27 


work, and died in his working attitude, cross-legged 
on his mat; and a merchant, concluding a bargain, 
vomited twice, and instantly expired. At Mecca, 
individuals in perfect health were suddenly stricken 
to the earth, vomited, turned cold, and died. Be- 
tween these two extremes the merciful admonitions 
are of various duration, from a few hours to a few 
days; in the large majority of cases the disease takes 
from six to thirty-six hours to fully develop itself, 
and terminates by death or convalescence in from one 
to two days from the inception of collapse. 

Sometimes the patient sinks at once, after discharg- 
ing a small quantity of colorless fluid by vomiting 
and stool; sometimes the vomiting and purging are 
preceded by the spasms. Sometimes the matter 
vomited, instead of being colorless or whey-like, or 
like seething of oatmeal, is green, and the dejections 
instead of being thin, and whitish and muddy, are 
red and bloody; or they may even consist of a green- 
ish pulp, like halfdigested vegetables. 

We have described the cramps as usually beginning 
in the extremities, and thence creeping gradually to 
the trunk; but in some cases they are simultaneously 
in all; and sometimes the order of succession is re- 
versed, the abdomen being first affected, and then 
the hands and feet. Generally, neither the vomiting 
nor the purging is a symptom of long continuance ; 
either they are checked by art, or the enfeebled body 
is no longer able to perform those violent motions ; 
so that they, together with the cramps, usually dis- 
appear some time before death. After the first 


28 VARIATIONS IN THE SYMPTOMS. 


emptyings of the bowels, the stools have been ob- 
served to be yellowish, turbid, or frothy like yeast, 
and though generally inodorous, they sometimes emit 
a rank, fleshy smell. The dejections are seldom at- 
tended with much griping, and sometimes they are 
effected without effort or uneasiness, though generally 
the calls are suddén and irresistible, and the dis- 
charges expelled with alarming force. Tenderness 
of the belly, on pressure, is not among the most 
common symptoms, nor, we repeat, are the vomiting 
and purging by any means the most important or 
dangerous; in a great number of fatal cases they 
have not been profuse, and have ceased, even with- 
out remedies, early in the attack. 

The cramps sometimes precede the vomiting and 
purging ; but in the low and most dangerous form 
of cholera, spasm is often absent, or is present in a 
very slight degree. Tetanic spasms of the legs, 
thighs, and loins have been observed, but there is 
no general tetanus (lock-jaw) or even trismus. Hic- 
cough in Cholera is not indicative of danger; on the 
contrary, when it occurs in the interval of struggle 
between death and reaction, it is a favorable sign, 
and generally announces the return of circulation. 
The spasm at the pit of the stomach is often very 
acute, and the belly is almost always drawn toward 
the spine by aremarkable permanent contraction of 
the abdominal muscles. 

The pulse oceasionally, though rarely, keeps up 
tolerably for several hours after the disease has 
plainly declared itself. Generally it becomes small 


VARIATIONS IN THE SYMPTOMS. 29 


and accelerated at an early stage, and on the acces- 
sion of spasm or vomiting, suddenly disappears from 
the extremities. On the cessation of the vomiting 
or spasin, and sometimes, apparently, from the ex- 
hibition of remedies, the pulse will return to the 
extremities for a short time, and then again be lost. 
In the less severe cases it is not wholly extinguished, 
though much reduced in volume, and a thread of 
pulse, however small, is almost always felt at the 
wrist, where recovery from the blue or cold stage is 
to be expected. The sinking of the pulse in Cholera 
is a symptom not less characteristic than the ca- 
daverous countenance, or the hoarse, plaintive whis- 
per (vow cholerica), or the discolored skin, or the 
chilled breath ; when it can be felt, it is generally 
regular and extremely feeble, ‘“‘ sometimes soft, not 
very quick, usually ranging from 80 te 100.” 

In the state of the skin, as in the other symptoms 
of Cholera, striking variations are found. The sur- 
face is sometimes observed to be dry, though cold ; 
and in a few rare cases, natural—‘‘ nay, of preter- 
natural warmth.” Arise of temperature has been 
repeatedly observed to take place just before death ; 
but the development of heat under such circum- 
stances appears to be confined to the trunk and 
head, and in almost all cases may be regarded as a 
fatal symptom. It is not indicative of any restora- 
tion of the diffused energy of the arterial system, or 
of any improvement in the function of respiration. 
The heat, in such instances, has continued well 
marked for seme hours atter death. The skin, in 


30 VARIATIONS IN THE SYMPTOMS. 


complete collapse, is generally insensible even to the 
action of chemical agents, and hence the usual vesi- 
catories fail to blister. The application of mineral 
acids or of boiling water, in this condition of the 
skin, produces little or no effect, and now and then 
a patient is found who is insensible to the operation ; 
nor can leeches draw blood, from an early period of 
the attack. 

The dlueness, so characteristic of Cholera in the 
East, has by no means been found an invariable, or 
even avery common phenomenon in England or the 
United States. Dr. White, one of the physicians 
to the Gateshead Dispensary and Cholera Hospital, 
states that in scarcely one case in ten, in his prac- 
tice, did the discoloration assume that form; but 
there is often a deep, brownish hue of the face and 
hands. This plueness or brownness can often be 
temporarily dissipated by energetic friction. Ab- 
sence of the peculiar “cold sweat” is a rare, and, 
we believe, a decidedly unfavorable sign. 

The urine, from having been limpid and free, will 
become more and more scanty, and its passage will 
sometimes be attended with such difficulty as almost 
to amount to strangury; but as the collapse ad- 
vances, this condition gives place to that in which 
the kidneys have eeased to perform their office, and 
there is no more secretion. Some patients complain 
of an urgent and painful desire to empty the bladder ; 
but the bladder is empty already, and after death is 
found to be dwindled to the smallest size ; the desire 
may arise from the contraction of the posterior disc 


VARIATIONS IN THE SYMPTOMS. 31 


of the bladder, hard against the internal meatus, as 
disclosed in post-mortem examinations. 

The pains of Cholera are agonizing to the sufferer, 
and at times so pitiful as to move the attendants to 
tears. The patient tosses incessantly from side to 
side, and complains of intolerable weight and 
anguish at his heart. As he struggles for breath, 
his imploring looks and gestures make you almost 
feel the horror that is burning and gnawing, and 
wrenching and rending at his stomach and chest. 
At times, especially when the cramps are most 
severe, he rolls about and screams—and then there 
is that weary, weary cry for “‘ water, water, water,” 
and that heart-rending, haunting wail when the cold, 
bony grip of death is on him. 

Violent headache is far from being a common 
symptom in cholera—a neuralgic pain over one eye 
is less rare. The cramp is invariably increased on 
moving. In some cases the patient declares himself 
free from pain and uneasiness, just when the dead- 
cold skin and the sharpened, anxious features, and 
the absence of pulse at the wrist, most surely por- 
tend speedy dissolution. 

During all this mortal struggle and commotion in 
the body, the mind remains clear and the perceptions 
unimpaired, almost to the final moment of existence. 
“The patient, though sunk and overwhelmed, list- 
less, averse to speak, and impatient of disturbance, 
still retains the power of thinking and of expressing 
his thoughts, so long as his. organs are obedient to 
his will.” The mortal lies all down-beaten and dis- 


32 VARIATIONS IN THE SYMPTOMS. 


traught, but the immortal is still master of itself. 
Dr. Lawrie, Professor of Surgery in the Andersonian 
University, who closely observed the epidemic as it 
appeared at Sunderland, Newcastle, and Gateshead, 
in 1832, commenting upon the declaration of the 
majority of medical men, that the mind is always 
unimpaired, says it appeared to him, in many cases, 
affected to a degree little short of what we find in 
concussion of the brain. He remarked this particu- 
larly in several children ; when undisturbed, they lay 
in a dull, sleepy, semi-comatose state, breathing with 
perfect calmness; when roused, they thought only 
of relieving their distressing sensations, and called 
- vociferously for cold water. But he does not say 
that he found them irrational or incoherent, or that 
their condition was other than that which should 
attend upon congestion of the vessels of the brain. 


EVs 
THE STAGE OF FEVER. 


A patient, having once fairly entered the stage of 
collapse, is rarely restored to health without passing 
through a fever closely resembling the typhus mitior 
of Great Britain. The system, under the influence 
of the peculiar and mysterious poison by means of 
which the Asiatic Cholera does its work, has been 
sunk into the lowest state of human existence. 
Those vessels that had ceased to pulsate, and all 
those muscular fibrils that had been for days con- 
vulsed, contracted, and, as it were, knotted and 
twisted in spasm, cannot at once resume their 
healthy action. The vis medicatrix nature, mn 
resuming its efforts, seems over-eager for the resto- 
ration of the functions, and consequently sets up an 
exaggerated and dangerous action in every artery. 
After the “blue” cold period has lasted from 12 to 
24, seldom to 48 hours, the vital powers begin to 
rally, the circulation and animal heat to be restored, 
the cramps to relax, and the vomiting and purging 
to diminish, if they have not already ceased. The 
warmth returns gradually, the pulse rises in strength 
and fullness, and then becomes sharp, and sometimes 
hard. The patient now complains of headache, with 
ringing in the ears. The tongue becomes more 
D* 


34 THE STAGE OF FEVER. 


loaded, redder at the tip and edges, and dryer; 
thirst continues, but there is less nausea. High- 
colored urime is passed with pain, and in small quan- 
tities. ‘The pupil is yenerally dilated, and soreness 
is felt on pressure over the liver, stomach, and 
bowels. The stools are no longer like water ; they 
first become brown and thin—then dark, or black, 
and pitchy ; and for some days the bowels continue 
to discharge immense loads of vitiated bile. A pro- 
fuse critical perspiration may appear, on the second 
or third day, and leave the sufferer convalescent, but 
more frequently the quickness of pulse, and heat and 
dryness of skin are aggravated, the tongue becomes 
deeply furred, brown and dry, and sometimes hard, 
the eyes suffused and drowsy ; there is a dull flush 
on the face, with stupor and heaviness. Commonly, 
at this time, there is low muttering delirium, or 
other marked disorder of the brain; dark sordes 
collect on the lips and teeth, the patient is pale, 
squalid and low, catches his breath, is extremely rest- 
less, and moans “solemnly.” The pulse becomes 
weak and tremulous; on the skin rigors alternate 
with flushes of heat. Then comes a blessed insensi- 
bility, and the patient soon sinks under the prostrat- 
ing effects of frequent pitchy alvine discharges— 
death arriving on the sixth, eighth or tenth day, or 
even later, to the very individual whom the most 
assiduous attentions had barely saved in the cold 
stage. Constipation is not an uncommon symptom 
in the febrile stage, and the urine is often secreted 
abundantly—in fact, dangerous retentions are to be 


THE STAGE OF FEVER. 35 


guarded against. It is probable that the duration 
of the consecutive fever is, in the majority of Euro- 
pean cases, commensurate with the duration and 
severity of the collapse, and not materially depend- 
ent on the kind of remedies employed. But some- 
times a very mild case precedes a dangerous fever, 
especially in Europe ; and sometimes after the seve- 
‘rest collapse, there is no fever at all, especially in 
India.! In England the consecutive fever has been 
regarded as more frequently fatal, unless strictly 
watched, than collapse itself; and in cases of recov- 
ery from even mild forms of fever, relapses, more or 
less alarming, have not been very uncommon there. 

The points of difference between the phenomena 
of the European and the Indian forms of the epi- 
demic, were intelligently stated by Drs. Russell and 
Barry, in a joint report to the British Government, 
dated “St. Petersburg, July 27, 1831,” and by Dr. 
Lawrie, of Sunderland and Newcastle, in a commu- 
nication to The Medico-Chirurgical Review, in 1832. 
We believe that the same points of difference will 
be observed in the epidemic now advancing towards 
these shores: 

First.—“ The premonitory stage occurs in a much 
larger proportion of cases in the English than in the 
Indian disease. In the latter it is the exception, in . 
the former it is the general rule.” 

[The writer of the present article can verify, from 
personal observation, so much of this statement as 
relates to the phenomena of Cholera in Malacca, 
Burmah, and Hindostan.] 


36 THE STAGE OF FEVER. 


Secondly.— The evacuations, both upward and 
downward, seem to have been much more profuse 
and ungovernable in the Indian than in the Kuro- 
pean Cholera, though the characteristics of the evac- 
uations are precisely the same.” 

Thirdly.—* Restoration to health from the cold 
stage, without passing through consecutive fever 
of any kind, is far more frequent in India than in 
Russia or England, nor does the fever in India 
assume a typhoid type.” 

[Recovery directly from the cold stage, without 
the fever, is the rule in India; whereas, in England 
or in the United States, we believe that few, who 
have been once fairly Seat will escape the con- 
secutive fever. | 

Hourthly.— The borne of deaths in the cold 
stage, compared with those in the hot, is far greater 
in India than in Western Europe.” 

Fifthly.—* The head is more frequently affected 
in the British than in the Indian form of Cholera— 
as shown by greater mental oppression and insensi- 
bility during collapse.” 

Siathly.—According to Dr. Lawrie, “the discol 
oration of the surface is neither so frequent nor so 
extensive in India as in England.” 

[The dfuve is the common discoloration in India, 
the drown in Europe; though in many cases, in both 
England and this country, there has been a well- 
marked purplish change. | 


When we come to consider the pathology of Cho- 


THE: STAGE OF FEVER. ay 


lera, the reader’s mind will revert to some of these 
variations and phenomena, as confirming our views 
of the nature and process of the morbid changes, 
and of the treatment scientifically and logically indi- 
cated. 


Y; 
RECOVERY—TRUE AND FALLACIOUS. 


Wuen the more formidable symptoms of collapse 
have set in with severity, the chances of recovery 
are in all cases precarious; and if the constitution 
has been impaired by previous disease, or has failed 
by reason of age, the case has always been regarded 
as nearly hopeless. But in childhood, youth, and 
the vigor of life, a well-instructed, sagacious, cou- 
rageous and persevering use of remedies will often 
be rewarded with complete success. 

A thread of pulse, however small, is almost always 
felt at the wrist where recovery from the “blue” or 
cold stage is to be expected. In much less formidable 
cases, it is never wholly extinguished, though much 
reduced in volume; the respiration, too, is less embar- 
rassed, and the oppression and anguish at the chest 
are not so overwhelming, although vomiting, purg- 
ing, and cramps may have been more intense. Just 
where the favorable turn is taken, in the first feeble 
efforts at reaction, the return of circulation is often 
curiously announced by hiccough. Then the surface 
begins to grow warm, the pulse reappears at the 
wrist, and increases in strength and volume, and the 
natural hue of the skin is restored. Next, the vom- 
iting and purging cease, or rapidly diminish (in 


RECOVERY—TRUE AND FALLACIOUS. 39 


certain cases of recovery from extreme collapse 
they even return for a time, after having quite dis- 
appeared) ; the cramps are relaxed; fecal matter 
reappears in the stools; bile, urine, and saliva are 
once more secreted and discharged; the voice 
becomes stronger and more natural—the racked 
and broken wretch sighs, weeps, and lives. 

When the vital forces have begun to rally, the 
physician cannot be too vigilant; he must watch 
nature warily, suspiciously, to prevent the recur- 
rence of collapse on the one hand, to repel conges- 
tions of the head and viscera on the other. Where 
the strength of the patient’s constitution, or the 
curative means employed, are, although inadequate 
wholly to subdue the disease, sufficient to resist the 
violence of its onset, nature makes various efforts to 
rally, and holds out strong but fallacious promises 
of returning health. Or when the restorative efforts 
are opposed by previous organic disease, general 
feebleness of constitution, or the worn-out energies 
of age, we must not calculate too confidently on any 
imperfect reaction that may be induced. In all 
such cases, the lost heat may be wholly or partially 
restored; if only partially, the chest and abdomen 
will become warm while the limbs remain deadly 
cold—a most evil omen; the pulse may return, 
erowing moderate and full; the vomiting and 
cramps may cease; the stools may become green, 
pitchy, and even feculent; there may be a partial 
restoration of the natural excretions; and yet the 
patient will suddenly relapse and sink, “not from 


40 RECOVERY—TRUE AND FALLACIOUS. 


violent reaction or the development of any local 
inflammation, but from want of energy in the vital 
powers to carry forward the attempts at restoration 
which seemed go happily begun.” ‘The sufferer may 
have fallen into a flattering slumber ; but now anxiety 
and sleeplessness will return, and all the alarming 
symptoms be reéstablished. These ignes-fatuc of 
rallying sometimes flicker for two or three days, 
and all that time life and death will be poised in a 
sensitive balance. In some of the most rapidly fatal 
cases, warmth has partially returned to the surface, 
and the pulse has fluttered and flattered immediately 
before death. Be it remembered that the real dan- 
ger is by no means in proportion to the quantity of 
matter discharged from the stomach and bowels. 
In some of the most trying cases this is not very 
considerable, and in some of the most successful it 
has been very great. Neither is cramp or spasm a 
sure criterion. The great danger arises from sus- 
pended or imperfect circulation. Restore and equal- 
ize this, and you have “ cured the Cholera.” 


VI. 
APPEARANCES ON DISSECTION. 


THE appearances disclosed on post-mortem inspec- 
tions of the bodies of those who have died of Cho- 
lera, vary according to the duration and intensity 
of the attack, the age, constitution, and previous 
health of the “ subject,” and the remedies adminis- 
tered; but enough of uniformity is found in the 
reports of the most instructed and careful observers 
—especially as to the points most significant, and 
of the first pathological importance—to serve the 
purpose of a description addressed to the unprofes- 
sional multitude ; enough, too, we think, to afford an 
accurate definition of the disease, in place of the 
bewildering guess-work of the text-books. In the 
language of the Medico-Chirurgical Review, “The 
man who would treat disease successfully, must not 
consider his only aim and object to be the knowl- 
edge of the various morbid changes which take 
place in the structure of the different organs, and 
of the symptoms by which ,they are distinguished ; 
his researches must be directed beyond this—to the 
laws of vital actions, to the manner in which they 
are disordered, and to those agents capable of re- 
storing them to their healthy state.” 

The bodies of those who have sunk in the earlier 


42 APPEARANCES ON DISSECTION. 


stages of Cholera exhibit hardly any unhealthy ap- 
pearance; the stomach and intestines are apt to be 
paler, and more distended with air than usual, and 
some explorers have discovered, fancifully perhaps, 
a ‘characteristic feetor” from the abdominal cavity. 
But in the more protracted cases, a greater or less 
degree of injection of the mucous membrane, with 
occasional ecchymosis, is the most frequent appear- 
ance. It has also been observed, in cases where the 
violence of the spasms proved the most prominent 
symptom, that the mucous membrane presented 
that appearance which approaches nearest to inflam- 
mation. The large intestines are sometimes filled 
with whitish and flaky-turbid fluid, sometimes with 
greenish, yellow, or tarry matter—in other words, 
with the characteristic discharges, or with vitiated 
pile, just as the patient may happen to have died in 
the earlier or later period of the attack, in collapse, 
or in the struggle for reaction. In like manner the 
stomach contains either the ingesta in an unaltered 
state, or the same “veal-soup-like” stuff that the 
patient has been vomiting; or its contents may be 
green or dark. So, likewise, as to the vascular ap- 
pearances presented by the alimentary canal, the 
varieties seem to correspond, with instructive regu- 
larity, to the duration, the stage, and the intensity 
of the attack. The mucous membrane is generally 
somewhat softened ; sometimes of an unusual pale- 
ness throughout, “but oftener having various por- 
tions tinted of various hues,” from the pale rose to 
the dark brick-dust and slate-colors, as venous or 


APPEARANCES ON DISSECTION. 43 


arterial injection predominates; patches of ecchy- 
mosis and arborizations of the larger branches are 
frequent; but the most common appearances have 
been a red or purplish speckling of the mucous 
membrane, generally over the whole surface, but 
more apparent in some parts than in others. Some- 
times these different appearances are scattered 
throughout the entire extent of the alimentary canal ; 
at other times the stomach alone is colored and the 
intestines pale, or the stomach pale and different 
portions of the intestines darkly injected. The 
venous trunks of both stomach and intestines are 
generally found remarkably engorged. The rule, 
divested of its numerous exceptions, or rather modi- 
fications, dependent upon circumstances and condi- 
tions which the intelligent physician will not fail to 
take into the account of each individual case, is: 
Where the patient has not lingered, but succumbed 
early to a rapid attack—no striking vascular change, 
beyond general venous congestion, and turgidity of 
the prominent vessels. Where collapse, in its com- 
pletest form, has been developed, repelling and dam- 
ming the current of the blood—universal dark en- 
gorgement, with deep discoloration of the internal 
surface of the stomach and intestines. Where the 
disease has been protracted, and has reached the 
stage of consecutive fever—every degree of arterial 
injection, in addition to the congestion, from the 
lightest blush to the angry flush of exaggerated action 
and incipient inflammation. These are the keys to the 
stages ; the mad malady rings many a change on them. 


44 APPEARANCES ON DISSECTION. 


The liver is commonly found enlarged and gorged 
with blood, but not always. In some cases it is 
soft and light-colored, and not very turgid; in 
others it is even collapsed and flaccid. The gall- 
bladder is, almost without exception, full of dark 
green or black bile. The spleen and kidneys are 
not always surcharged with blood; quite frequently 
they present a perfectly natural and healthy appear- 
ance. The bladder is always empty and contracted. 
The lungs have often been found in a natural state, 
even in cases where there has been much oppression 
of respiration. Much more commonly, however, 
they are either gorged with dark blood, so that 
they have lost their characteristic appearance and 
have rather assumed that of the liver or spleen, or 
they are remarkably collapsed, their bulk so much 
reduced that they lie in the hollow on each side of 
_ the spine, leaving the cavity of the thorax nearly 
empty. In the majority of cases the heart and its 
larger vessels are distended with very dark blood. 
All the cavities of the heart are filled with a thick, 
blackish treacle; and blood so dark that, when ex- 
tended on a white surface, it resembles in color the 
juice of the darkest cherry, is often found in the 
arch of the aorta and in the other great arterial 
trunks. The principal venous vessels are usually 
found engorged—the most forcible injection could 
not have more completely filled them—and the con- 
tained blood is dark and sirupy. The vessels and 
membranes of the brain are frequently turgid with 
blood, particularly towards the base. <A fluid is 


APPEARANCES ON DISSECTION. 45 


sometimes found effused into the convolutions in 
considerable quantity, with more or less serum in 
the lateral ventricles. The blood-vessels of the 
vertebral column and spinal cord may be noticeably 
congeste.!, and in some cases there are marks of in- 
flammatory congestion in the larger nerves. But 
the cases in which the brain presents a natural ap- 
pearance, and those in which the sinuses and the 
veins leading to them are stuffed with almost black 
blood, are of equally common occurrence. 


VII. 


HELPS AND HINTS TOWARDS A PATHOLOGICAL 
DEFINITION. 


THE consecutive fever of Cholera is not an integrant 
and necessary part of the disease. It cannot be 
distinguished from an ordinary continued fever, 
except by the rapidity and fatality of its course. 
It is the result of nature’s effort to recover herself 
from’ the stunning shock that has prostrated her, 
and the oppression that keeps her down. 

Cholera is only cognizable with certainty during 
the cold or “blue” period; of the three stages, the 
collapse alone is true Cholera. 

Where medical measures have been promptly, 
energetically and successfully employed, the essen- 
tial and diagnostic symptom, sudden sinking of the 
circulation, has often not developed itself; and 
there are cases where an excited vascular action has 
accompanied the first tumult of the system in Cho- 
lera. ‘These are precisely the cases which yield 
most certainly and promptly to the remedial meas- 
ures. In India it has been observed that these 
favorable indications chiefly appear among the 
European soldiers, who usually imbibe spirits freely 
at the commencement of the attack. During an 
- invasion of Cholera in Malacca and Burmah, in 


A PATHOLOGICAL DEFINITION, 44 


June and July, 1852, the writer of this had medical 
charge of an East India Company’s war steamer in 
the Bay of Bengal and the Straits of Malacca. The 
ship’s company was composed of Europeans and 
natives— Malays and Mohammedans—in about 
equal proportion. Under the peculiar treatment, 
to be described further on, not a single case of col- 
lapse occurred among the Europeans, all of whom 
“indulged ” liberally, the officers in wine and toddy, 
the men in their regular grog, twice or three times 
a day, and in irregular “drinks” as often as they 
could get them; whereas, among the natives, most 
of whom were abstemious by reason of “ piety” or 
vows, every case was collapsed; but the recoveries, 
even from the cold stage, amounted to eighty-five 
per cent. 

If the superficial veins and arteries be opened in 
the cold stage, the contained blood may flow out ; 
but their walls then collapse, and no more blood 
can be drawn. There is no authentic fatal case of 
Cholera on record where the circulation has not 
been arrested, in the extremities at least, long be- 
fore death. 

An increase of temperature is often observed, just 
before dissolution; but the development of heat in 
such instances is partial, being confined to the 
trunk and head, and is a fatal symptom. This 
mocking warmth is generally appreciable. for some 
hours after death. 

The application of boiling water to the skin, in 
the worst cases of collapse, produces little or no 


48 A PATHOLOGICAL DEFINITION. 


effect, and some patients are insensible to the opera- 
tion; but it is certain that in a body but just dead 
of some other disease, boiling water will vesicate 
readily. So extreme is the diminution, or so com- 
plete the destruction, of the nervous energy of the 
skin in the cold collapse of Cholera, that there is 
less vitality there in such cases, the patient being 
still alive, than in the skin of a body recently dead 
of a different disease. The writer has applied boil- 
ing water to the feet and legs of patients in India, 
without eliciting a tone or gesture of complaint. 

The change in the condition of the blood—“ dark, 
black or tarry, thick, ropy or sirupy”—is fully 
proved to be in the ratio of the duration of the 
disease, the blood more or less rapidly changing 
from a natural to a morbid state as the disease 
advances; such is the general rule. Observe that 
the blood is usually found to be less changed in 
those cases of Cholera which are ushered in with 
excitement, than where collapse has occurred at an 
early period of the attack. 

The blood is sometimes found, on dissection, to be 
of as dark a color in the left as in the right side of 
the heart, affording reason to believe that in the 
whole arterial system it is equally changed. In 
many cases the temporal artery has been opened, 
after attempts to procure blood from the brachial or 
jugular veins had failed, and the blood in the artery 
was found dark and thick, like the venous blood; it 
flowed in a languid, ropy stream, and then the ar- 
tery collapsed. 


A PATHOLOGIGAL DEFINITION. 49 


{liccough is a favorable sign, and seems to an- 
nounce the return of circulation, especially when it 
occurs in the intermediate moments between the 
threatening of death and the beginning of reaction. 

While burning thirst, pain at the stomach, cramps, 
asphyxia, clammy sweat, cadaverous coldness, and 
aphonia, may all be present, vomiting and purging 
may be absent, and “‘ yet”’ the case will rapidly run 
to a fatal termination. The fact is, the vomiting 
and purging are not only “far from being the most 
important or dangerous symptoms ”—it is not only 
true that “the danger of the case is by no means 
dependent on the quantity of matter discharged 
from the stomach and bowels,” and that “in some 
of the worst cases this is not very considerable, and 
in some of the most fortunate it is very great ”’— 
but it is our conviction that the vomiting and purg- 
ing are, in their original intention, genuine efforts of 
nature to relieve the engorged vessels, and restore 
the equilibrium of the circulation; that they con- 
stitute nature’s safety-valve to the congestion; that 
their presence, 77 collapse, is generally a favorable, 
and their sudden disappearance a very unfavorable 
sign. ‘They almost invariably cease a short time be- 
fore death in the cold stage; they frequently return 
ina notable degree at the beginning of reaction. 
Mr. John Fyfe, of Newcastle, England, attended 
579 cases of Cholera; and in all these, he says, col- 
lapse never came on “until after profuse serous 
discharges from the bowels.” Was not nature, by 
those discharges, struggling to prevent the collapse ? 

3 


50 A PATHOLOGICAL DEFINITION. 


—in the language of Dr. James Johnson, Physician 
Extraordinary to the King of England, was she not 
making “violent, but too often unsuccessful, efforts 
to restore the broken balance of the circulation, and 
to reéstablish the secretions, by sickness and purg- 
ing—the ejected fluids being exudations, not secre- 
tions ?” Here nature cries to us for help, and shows 
us how to help her—disclosing to us the inner mys- 
tery of Cholera. If we do not make haste to aid 
her in the direction she points out, she will exhaust 
herself by her own tremendous efforts. 

In Cholera there is every reason to believe that 
every species of secretion, in all parts of the body, 
is abolished. No known function of the mucous 
membrane of the alimentary canal could form 
matter like that which is discharged ; and as there 
is no circulation going on in the skin, but rather a 
complete state of asphyxia there, there can be no 
secretion of perspiration. The “cold sweat” of 
collapse is not true perspiration (like the critical 
perspiration of the consecutive fever), but exuda- 
tion; and, viewing the skin and the mucous mem- 
brane as one continuous surface, itis just to conclude 
that this exudation is homogeneous throughout. 
“Whence, then, and how, come these discharges? 
On the skin, certainly not from circulation, for there 
is none there; and it is more than probable that the 
capillary circulation of the mucous membrane of the 
intestines is equally absent. It would seem as if the 
elements of the body, composing the parts nearest 
to the surfaces, became subject to new affinities, 


A PATHOLOGICAL DEFINITION. 51 


forming a new substance, incapable of being retained 
by the membranes, but rapidly oozing through them. 
Two facts go to support such a hypothesis: First, 
the abundant new formation transuded, where no 
circulation exists; and second, the rapid amaigrisse- 
ment of the body. This wasting of the body is not 
merely apparent, it is real; the usual roundness of 
the parts is taken off, and tendons and other salient 
points become strikingly prominent.” We quote 
from the report of Dr. Robert Nelson, member of 
the Medical Board, and Commissioner of Health at 
Montreal. 

Of the two great classes of functions performed 
by the organs of which man is composed, one only is 
primarily paralyzed by the poison of Cholera. The 
operations of the senses, and of the intelligence, are 
either left untouched or are affected but in a second- 
ary manner. It is the animal that dies; the intelli- 
gence, awe-stricken, surveys the scene of death, and 
trembles and wonders. Those functions by which 
mere existence 1s preserved—those complicated 
powers by means of which we are forever appropri- 
ating, and converting into a part of ourselves, por- 
tions of the matter around us—are, all at once and 
all together, deranged and disabled by the blow of 
this terrible angel. Nutrition is annihilated; respi- 
ration becomes difficult, irregular, and inefficient ; 
the involuntary muscles no longer perform their 
offices; the voluntary are contracted in painful knots 
by other powers than the will; the blood ceases to 
circulate ; its physical properties are altered, its 


52 A PATHOLOGICAL DEFINITION. 


serous element suddenly thrown out upon the in- 
testinal mucous surface of the body; the secretions 
are all arrested, and animal heat is no longer pro- 
duced. 

After the first, or premonitory stage, bile ceases 
to be formed. We always find the gall-bladder full ; 
but this filling has taken place before collapse set in. 
There are no signs of bilious absorption. 

The victim of Cholera does not die “solely of 
starvation, caused by vomiting and diarrhea,” as 
certain doctors hold; but by paralysis of a portion 
of the nervous system, and consequent chemical and 
organical decomposition of the blood. 

During the prevalence of Cholera, there are often 
observed among persons otherwise healthy various 
anomalous affections of the nervous system—such 
as cramps, cold sensations of the hands, feet, and 
legs, a peculiar thrilling in the extremities of the 
fingers and toes, and an oppressive feeling of anxiety 
in the region of the heart. 

Adult age exhibits a much more lively suscepti- 
bility to the Cholera poison than early life; great 
numbers of children escape it, simply because they 
are less subject to the predisposing influence of 
Fear. | 

The idea of bleeding, in the stage of collapse, has 
its origin in a hydraulic theory totally inadmissible 
in Cholera. There is not too much blood in the 

‘whole body, but too much at the centres and too 
little at the surfaces. A return to healthy distribu- 
tion and circulation will not result from abstracting, 


A PATHOLOGICAL DEFINITION. 53 


any more than from adding, a portion of the dam- 
med-up mass. ‘The cessation of arterial action is 
not owing to the state of the fluids, but to determi- 
nate derangement in the nervous power, by which 
the machinery of circulation has been stopped. Be- 
sides, in most cases you cannot bleed; thickened 
and stagnant in the vessels, the blood cannot be 
made to flow; and if afew ounces be squeezed from 
the orifices, it hangs from them in long tarry strings 
—to no purpose. 

The experiment of galvanizing is a kindred ab- 
surdity. The desideratum in Cholera is not the ‘sup- 
ply or restoration of vital or nervous power, but 
the propulsion of that power to the surface from 
which it has receded. 


NULL 


PATHOLOGICAL CONCLUSIONS. 


“ Not in the world of Light alone, 
Where God has built His blazing throne, 
Nor yet alone in earth below, 
With belted seas that come and go, 
And endless isles of sunlit green, 
Is all thy Maker’s glory seen; 
Look in upon thy wondrous Frame— 
Eternal Wisdom still the same! 


“The smooth, soft air, with pulse-like waves, 
Flows murmuring through its hidden caves, 
Whose streams of brightening purple rush, 
Fired with a new and livelier blush, 

While all their burden of decay 
The ebbing current steals away, 
And red with Nature’s flame, they start 
From the warm fountains of the Heart. 


“No rest that throbbing slave may ask, 
Forever quivering o’er his task, 
While far and wide a crimson jet 
Leaps forth to fill the woven net 
Which, in unnumbered crossing tides, 
The flood of barning Life divides; 
Then, kindling each decaying part, 
Creeps back to find the throbbing heart. 


* * * * * * * 


“Then mark the cloven sphere that holds 
All Thought in its mysterious folds, 
That feels Sensation’s faintest thrill, 
And flashes forth the sovereign Will ; 
Think on the stormy world that dwells 
Locked in its dim and clustering cells ! 
The lightning gleams of power it sheds 
Along its hollow, glassy threads! ” 
Homes. 


In 1831, Dr. James Johnson, whose clear-sighted 
deductions have thrown so much informing light on 
the nature of Epidemic Cholera, and who was at 
that time editor of The Medico-Chirurgical Review, 


PATHOLOGICAL CONCLUSIONS. 55 


and Physician Extraordinary to the King of Eng- 
land, submitted to the Westminster Medical So- 
ciety a series of propositions, embodying his views 
of the pathology of the disease—views that have 
never since been contravened, and to the convincing 
completeness of which no later observations have 
materially added. We extract the essence of those 
propositions: | 


“J. That in Epidemic Cholera, as in most other epide- 
mics, a poison or sedative principle—whether emanating 
from the earth, from animal or vegetable matter on the 
earth, or engendered in the air—strikes a predisposed in- 
dividual, and, after an uncertain period of incubation, 
produces a train of phenomena, forming the subject of sub- 
sequent propositions. In Sporadic Cholera (that is, common 
cholera morbus), the general or diffusive cause is absent; 
but when the common exciting causes are strong, and the 
subject highly predisposed, severe or fatal cases will occur 
(even in that less formidable malady), where the symptoms 
cannot be distinguished from those of the malignant Hpi- 
demic Cholera.” 


[That ‘ Asiatic” Cholera arises from ‘ atmos- 
pheric distemperature,” and is diffused through, 
and conveyed by, the air, is evident from the fact 
that its appearance in any place is usually preceded 
by cases of cholera morbus, and the general preva- 
lence of disordered digestion ; and when the disease 
does appear as an epidemic, scarcely a single indi- 
vidual in the same locality escapes having some 
disorder of the stomach and bowels. Almost every 
one complains of diarrhea. Morcover, this atmos 


56 PATHOLOGICAL CONCLUSIONS. 


pheric distemperature is often so powerful as to 
affect animals. In January, 1827, in Caleutta, cat- 
tle, and even elephants, experienced the epidemic 
influence to such a degree that they died in great 
numbers. Everywhere in India, cattle and dogs 
have died of Cholera, goats and camels in Persia, 
monkeys in Burmah, chickens and turkeys in Mos- 
- cow, and in Prussia multitudes of fish. Within a 
week after the outbreak of the pestilence at Con- 
stantinople, in July last, the birds of all kinds, from 
the sparrow and swallow to the sea-gull and kite, 
absolutely disappeared from the capital, and by 
their return, early in September, announced with 
reanimating certainty the restored salubrity of the 
atmosphere. It was also said that the gilding on 
the caiques in the Golden Horn and the Bosphorus 
was tarnished, especially in those localities where 
the Cholera had raged most severely. | 


“IT, This poison manifests its effects according to the 
evidence of our senses: jist, on the nervous system, as 
evinced by the prostration of strength, by the arrest of the 
secretions—dependent on nervous energy—and, in fact, by 
a depression of the whole of the sensorial functions, as well 

as those of organic life.” 


[Symptoms curiously resembling those of Cholera 
are frequently observed to attend that sudden pros- 
tration of nervous energy, that shocking annihila- 
tion of tone, which follows upon a_ protracted 
debauch, especially in subjects of highly nervous 
temperament—that extreme depression into which 


PATHOLOGICAL CONCLUSIONS. 57 


persons so constituted usually sink from extreme 
excitement—that painful nervous back-springing 
and unbalancing from excessive physical or mental 
stimulation. In such cases there are often extreme 
weakness, sudden diarrhea, cold sweats, shiverings, 
sinking of the pulse, blue discoloration of the nails 
and lips and around the eyes, excruciating cramps 
creeping from the extremities to the trunk, distor- 
tion of the fingers, tingling and thrills in the muscles 
of the feet and hands, a sensation as if the balls of 
the fingers were applied to cold metal buttons, agi- 
tating anxiety about the region of the heart, tones 
and gestures of imploring helplessness, suddenly 
altered countenance, an expression of wandering 
apprehension, and even the hoarsely whispering 
voice. In like manner, the influence of extreme or 
prolonged fear upon the nervous system, often mani- 
fests itself in phenomena strikingly resembling what 
are called the premonitory symptoms of Cholera. | 


“TIT. The secondary effects of the choleraic poison are 
shown in the vascular system. The heart acts feebly, the 
circulation recedes from the surface, and the blood accumu- 
lates in the vessels of the internal organs; decarbonization 
and calorification cease, or are greatly diminished; the tem- 
perature of the body falls to that of surrounding inanimate 
substances; paleness is changed to blueness; and the influ- 
ence of the ganglionic system of nerves seems to be nearly 
suspended, if not annihilated.” 


[The reader has but to revert to what has already 
been noted in relation to the post-mortem appear- 


9° 
3*F 


58 PATHOLOGICAL CONCLUSIONS. 


ances, and the changes in the distribution, quality, 
and color of the blood, to appreciate the clearness 
of this proposition and the accuracy of its state- 
ment. The recession of circulation from the sur- 
face, and the utter loss there of all that elasticity 
which depends upon nervous vitality or tone, are 
evinced by the peculiar ‘‘ pudginess ” or dough-like 
quality of the skin, when it is pinched up between 
the thumb and finger. | 


“TV. It is at this period that nature appears to make 
violent, but too often unsuccessful efforts to restore the 
broken balance of the circulation, and to reéstablish the 
secretions by sickness and purging, the ejected fluids being 
exudations rather than secretions.” 


[It is in this view of their intention or tendency 
that the vomiting and purging are to be regarded 
as natural rallying exertions. | 


“V. Weare not, in our present state of knowledge, cer- 
tain whether the spasms are merely the effect of the poison 
on the nervous system, or an effort of nature to resist it; 
but they, like the vomiting and purging, tend ultimately (if 
not seconded) to exhaust the powers of life.” 


[The writer was led, by his observations in India, 
to the conclusion that the spasms do constitute such 
an “ effort to resist” the paralyzing influence of the 
_ choleraic poison, by restoring the continuity of the 
obstructed nervous current. | 


“VT. If nature (by which I mean the constitution), whe- 


PATHOLOGICAL CONCLUSIONS. 59 


ther with or without aid, be able to resist the first or 
depressive shock of the poison, and institute a reaction in 
the system, that reaction, in a great majority of cases, be- 
comes a fever, exhibiting a new train of phenomena, and 
demanding a different mode of treatment. If this view be 
correct, it would lead to the inference that the choleraic 
symptoms constitute the first or cold state of a choleraic 
féver.” 


[Or, a more logical definition, that the true cho- 
leraic symptoms are confined to the cold stage, and 
that from the moment that reaction is substantially 
set up, the disease ceases to be Cholera, and becomes 
continued fever. | 


“VII. If reaction, with restoration of circulation, secre- 
tion and oxygenation do not take place, the patient dies in 
a state of asphyxia, the intellectual powers often remaining 
but little impaired till the last glimmer of the lamp of life is 
extinguished. This has been often witnessed in concen- 
trated miasmal fevers, both within and without the 
tropics.” 


“VIII. All the changes which present themselves in the 
dead body are effects, not causes of the disease; with the 
exception of the congestion of black blood in the internal 
organs, which is almost the only phenomenon observable 
when Cholera terminates fatally in a few hours. The 
traces of inflammation in various organs after death, indi- 
cate the causes or effects of the reactive fever rather than 
of the Cholera which precedes that fever.” 


[This is not so well put. Why the exception? 
The course of the disease being in three stages— 


60 PATHOLOGICAL CONCLUSIONS. 


the premonitory, the cold, and the febrile—the 
second stage only being true Cholera, and the poison 
manifesting its effects first on the nervous system, it 
is clear that the congestion of black blood is the 
mechanical effect of paralysis of the nervous extremi- 
ties primarily, and secondarily and consequently 
of collapse of the superficial vessels, whereby the 
Whole volume of the blood is suddenly repelled from 
the surfaces to the centres, from the finer fila- _ 
ments to the larger branches, and so on to the 
great trunks, which are found loaded with thick 
black blood after death. ‘This is the whole process 
and sequence of engorgement and congestion, and 
therefore the congestion should be regarded as the 
effect of the Cholera proper, and the traces of vas- 
cular excitement and inflammation as the effect of 
reaction, and the cause of the consecutive fever. | 


“TX. As we have no means of expelling or neutralizing 
the poison, we can only endeavor to counteract its affects, 
and to assist nature in her remedial movements.” 


[The primary or essential indication is to restore, 
not “the equilibrium of the circulation,” as Dr. 
Johnson has it, but the impaired nervous vitality, 
the paralyzed nervous energy, whereby that equili- 
brium was lost. The balance of nervous power 
restored, the balance of circulation follows, of course, 
and then— secretion, calorification, oxygenation.” 
This is the signal that nature makes in the cramps, 
and the key-word is Revulsion. The galvanizers 
tried to answer it, but their error was the same in 


PATHOLOGICAL CONCLUSIONS. 61 


principle as that into which the bleeders fell; for 
the galvanizers insisted upon adding something that 
was not wanted, and which could not have been 
added if it had been; while the bleeders insisted 
upon taking away something that could not be 
spared, and which could not have been removed. | 


IX. 


EPIDEMIC CHOLERA AND CHOLERA MORBUS— 
THE DIFFERENCE. 


British CHoLtERA and Asiatic Cholera, Common 
Cholera and Malignant Cholera, Sporadic Cholera 
and Epidemic Cholera, Cholera and Cholera Mor- 
bus—these are terms commonly employed to mark 
the distinction between the two diseases. For our 
own part, we regard it as a fact established that, in 
their kind, they are one and the same; that the dif- 
ference is of degree, of intensity and fatality, merely, 
and the presence or absence of the diffusive cause. 
In the characteristic phenomena, we find the family 
likeness very strongly marked: vomiting and purg- 
ing, pain and cramp in the.stomach and bowels, de- 
jections at first thin and watery, afterwards bilious, 
great sickness and distress at the stomach, spasms 
in the muscles of the abdomen and extremities, in- 
tense thirst and craving for cold water, sinking of 
the pulse, cold arms and legs, dead-pale countenance, 
distressed expression, cold sweat, and extreme pros- 
tration. 

Sydenham described an epidemic Cholera Morbus 
that prevailed in England in 1669. In his opinion 
the disease did not differ from the Common Cholera, 
except that, that year, it prevailed epidemically. 


EPIDEMIC CHOLERA AND CHOLERA MORBUS. 63 


The Bombay Medical Board have declared that 
Sydenham’s description applies exactly to the Cholera 
of India. ‘Therefore the people of India might at- 
tribute their disease to importation from England.” 

A Report of the Royal Academy of Medicine of 
Paris says, “* The Cholera of India is, as to its symp- 
toms, the Cholera of the ancients; and except in 
intensity and danger, differs but little from ordinary 
Cholera.” The most accomplished physicians of 
England have indorsed this opinion. 

The physicians of Montreal regarded the epidemic 
of 1832 as differing in no respect from the endemic 
Cholera of the United States and the Canadas, 
‘save that now it is epidemic; the same organs are 
affected, and the same symptoms exhibited.” 

The common Cholera Morbus of the United States 
is usually considered a not very dangerous malady ; 
but most writers declare that it often is so, and that 
it frequently destroys life in a few hours. The de- 
scriptions of this disease, found in old medical works, 
always included the vomiting, purging, cramps, 
sweats, and most of the symptoms of Asiatic Cholera. 
Sydenham describes the first discharges as thin and 
watery; and Frank says, “ At first the egesta are 
like water—then as if flesh had been recently im- 
mersed in them; sometimes they are white;” and 
adds, “in the worst cases of Cholera the patients, 
exhausted by profuse discharges, and their torments, 
become collapsed in five or six hours, and look no 
longer like themselves.” Observe that it is of 
Cholera Morbus that he is writing. 


64 EPIDEMIC CHOLERA AND CHOLERA MORBUS. 


No symptoms have been described as characteris- 
tic of Epidemic Cholera that do not sometimes pre- 
sent themselves in Common Cholera. Much stress 
has been laid by certain observers on the difference 
in the discharges. On this point Zhe Medico-Chi- 
rurgical Review remarks: “If the fluids are colorless, 
it is considered a proof that the disease is Asiatic— 
if any bile, or other colored fluids appear, the disease 
is English. Yet the India Boards, and indeed all 
careful observers, have acknowledged that the dis- 
charged fluids form no criterion of the disease. The 
Bengal Board, for example, tells us that ‘the fluid 
ejected from the stomach was watery, mostly taste- 
less, transparent, or of:a whey or ash color. Some- 
times it was sour, green, dark, like infusion of tea, 
starchy, mixed with mucus, and viscid. In very 
rare cases, pure bile was thrown up.’ In respect to 
the alvine evacuations, ‘they were generally watery, 
colorless, white, or muddy—sometimes red and 
bloody—sometimes greenish and pulpy, like half- 
digested vegetables.’ Is it not preposterous, after 
this, to make the distinction between the Asiatic and 
the English disease to consist in the color of the 
motions? Nimium ne crede colori!” 

Dr. Jarvis, a very intelligent physician of North- 
field, Mass., communicated to Dr. Brigham of Hart- 
ford, Conn., a description of “a very singular and 
malignant disease” that prevailed at Warwick, a 
hilly town in Franklin County, Mass.,in 1831. The 
disease made its appearance in July, and in five 
weeks thirty-two individuals were attacked, of whom 


EPIDEMIC CHOLERA AND CHOLERA MORBUS. 65 


sixteen died. The malady manifested itself, in the 
first instance, by distress at the stomach, extending 
to the bowels; then by nausea, and vomiting, and 
frequent calls to stool; the discharges were white 
and watery. If the disease was arrested here, the 
dejections became bilious; but if not arrested, the 
vomiting increased; nothing could be retained on 
the stomach but opium; the discharges from the 
bowels were constant, and of a thin fluid, resembling 
rice-water ; there were cramps of the muscles of the 
abdomen and extremities, with intolerable thirst ; 
the skin became cold, shrunken, and of a leaden hue; 
the pulse weak, and often imperceptible ; the mind 
not weakened or disturbed, the patients manifesting 
but little anxiety about their condition, and con- 
versing freely to the last. 

These are but a few from the convincing array of 
facts that might be marshalled to prove that the Epi- 
demic Cholera of Asia differs from the Common 
Cholera Morbus of the United States in intensity 
and fatality only ; and that when the latter, by reason 
of its violence and favorable local circumstances, as- 
sumes an endemic character, there may remain but 
the difference of a letter between the two diseases. 


X. 
TREATMENT. 


SaLT, mustard, vinegar and oil, pepper, red and 
black, everything the casters afford, except tomato 
catsup and Jockey-club sauce—as if Cholera were 
chicken salad; wine, whisky, rum, and brandy, 
Apple Jack and Old Tom—everything the decan- 
ters, and nothing that the pitcher, supplies; rhubarb, 
senna, and castor-oil; scammony, colocynth, jalap 
and aloes; ipecacuanha, tartar-emetic, and sulphate 
of zinc; calomel in all stages and in doses of all 
sizes, from the homeopathic mite to the allopathic 
monstrosity; opium in all its forms, and by every 
imaginable mode of administration ; ether, camphor, 
musk, castor, aromatic and stimulating tinctures; 
essential oils of peppermint, clove, and cinnamon; 
extracts of hyoscyamus and cicuta, prussic acid, sub- 
nitrate of bismuth, colchicum, cinchona, serpentaria 
and capsicum ; oil of vitriol, spirits of turpentine, and 
for all we know, petroleum; brandy injections, soap 
injections, tobacco injections, warm drinks and ice 
water; tepid baths, cold baths, hot baths, vapor 
baths, hot sand, friction with irritating rubefacients, 
blisters, scalding water, mineral acids, red hot irons, 
cold water pumped on the spine and the pit of the 
stomach, bleeding, cupping, leeching, oxygen gas, 


TREATMENT. 67 


laughin gas, injections of saline solutions into the 
veins, electricity, galvanism, chloroform, clairvoy- 
ance, hasheesh, inhalation, Perry’s Pain-killer, Rad- 
way’s Ready Relief, Mrs. Winslow’s Soothing Syrup, 
Phalon’s Night-blooming Cereus, Constitution Life 
Syrup, and Mrs. Allen’s Hair Restorer. 

For heterogeneousness and promiscuousness, and 
elaborate and complicated stupidity and nastiness, 
we know of nothing in the whole range of English 
literature with which to compare the run-mad list, 
unless it be Mr. Timothy Tickler’s description of the 
spots on a steamboat table-cloth, in the Noctes Am- 
brosiane. Enough, that it represents every degree 
of “sagacity and energy,” from the most timid im- 
becility to the most self-sufficient recklessness, from 
“leaving the disease to Nature,” to murder with 
ageravating circumstances; and that it stands for 
the practice of all the gentlemen who have got 
themselves inoculated with other gentlemen’s theo- 
ries,—who have ripped with this Euripides of Vene- 
section, or socked with that Socrates of Vesication. 
Even if this were the place, and the time and space 
were ours, to explore and discuss the bewildering 
budget of notions, the labor were in vain. Our 
readers will thank us for proceeding at once to our 
demonstration of the method of treatment at which 
we long ago arrived, by way of the pathological 
conclusions already plainly stated, and by which 
eighty-five out of every hundred of the collapsed 
cases, and all of the premonitory cases, were reco- 
vered, in the Bay of Bengal in 1852. ° 


68 TREATMENT. 


But first, in this connection, it seems but fair that 
we should call attention to a fact which has been 
everywhere observed, and which may serve to ex- 
plain the honor in which certain remedies have been 
held in certain localities and seasons, only ta fall 
into contempt at other times and places. The 
causes that produce Cholera are always most violent 
at first; and after an early climax of fury, the dis- 
ease is observed to become more mild and manage- 
able. Remedies then appear to have more control 
over it, and the hope is entertained that the method 
of treatment adopted has lessened the mortality and 
triumphed over the scourge; but all such hopes are 
almost sure to be blasted on a recurrence of the in- 
vasion, or on trial of the same remedies in other 
places at the commencement of the attack. Dr. 
Lefevre, physician to the British Embassy at St. 
Petersburg, and who enjoyed the amplest oppor- 
tunities of observing the disease and ascertaining 
the most successful modes of treatment, remarks: 
“The Epidemic Cholera, on its first invasion, baffles 
all attempts to conquer it; but it gradually loses its 
intensity, and towards its decline, becomes as tract- 
able as other diseases of the alimentary canal.’ 
And Dr. David B. White, one of the physicians to 
the Gateshead Dispensary and Cholera Hospital, 
says: “ When Cholera first rages, its inveteracy is 
greater than at any subsequent period, and remedies 
which utterly fail in the first instance, acquire a re- 
nown and celebrity when nature herself is at work 
to assist them.” 


TREATMENT. 69 


So, what is true of the period of the invasion is 
equally true of the stage of the case: thus calomel, 
before reaction, has been pronounced all vanity and 
foolishness ; and bleeding, after reaction, has secfhed 
all wisdom and virtue. Mr. William Scot, in an old 
Report to the Madras Medical Board, on the treat- 
ment of Cholera in the Presidency of Fort St. 
George, says: ‘“‘ The suppression of the excretion of 
bile being only a link in the common chain of symp- 
toms, and the partial or occasional removal of that 
excretion, or even its total absence, having been 
proved to be of little consequence in the general 
course of the disease, to attempt to excite it by par- 
ticular means, may be considered as premature and 
injudicious. Whenever a favorable change takes 
place, indicated by a renewal of the ordinary func- 
tions, then the exhibition of the appropriate stimulus 
(calomel) seems to be clearly indicated, and not till 
then.” And Dr. Kinnis, in an account of the treat- 
ment at Port Louis, Mauritius, in 1820, anticipates 
the intelligent objections (to blood-letting) of many 
later observers, in the following words: “The im- 
pression produced on me is, that when only a few 
ounces of blood can be obtained, their abstraction 
accelerates the fatal event; and when bleeding can 
be carried to syncope, the disease is curable without 
it.” In other words, it is folly to bleed with the 
object of “restoring the circulation,” since if you 
can draw blood, it is because the circulation is 
already partially or completely restored; and if 
there is not circulation already, you cannot draw 


70 TREATMENT. 


blood, and your cutting and squeezing only weaken 
more and more the half-dead patient, and thwart 
and cripple nature. 

The fact is, nature is trying to do her own bleed- 
ing in her own way, and doing it in excess—by the 
profuse evacuations, we mean. In the language of 
Dr. Kirk: “ When was it proposed, till the present 
day, to relieve a condition of the extremest depres- 
sion, and of no arterial excitement, by the abstrac- 
tion of the principal vital fluid? Will the removal 
of a small column of venous blood change the con- 
dition of the rest of the sanguineous stagnance, or 
impart energy to those nerves which, under a poi- 
soned influence, have ceased to perform their impor- 
tant functions of giving life and action to the whole 
system?” No; the practice of bleeding, especially 
in the stage of collapse, admits not even of that 
similia similibus defence which may be set up for 
the tobacco injections, of which it has been said that 
when dogs are poisoned by them, the symptoms 
produced are precisely those of Cholera—purging, 
vomiting, cessation of the pulse, complete collapse. 

But in spite of our promise, we have digressed 
into debate, and with a thought of apology to the 
reader, we come back to the treatment which we 
believe has been conclusively proven to be the logi- 
cal and natural end to which the true pathological 
paths infallibly converge, and for which any one 
must be prepared who has followed us thus far on 
the trail of clear-sighted and keen-scented explorers. 

There are usually three stages to a case of Cholera 


TREATMENT. Tl 


—first, the premonitory or warning stage; second, 
the “ cold-blue,” or stage of collapse, which alone 
is true Cholera; and finally, the stage of consecutive 
fever, which is the result of reaction, and differs in 
no respect from a common continued fever. The 
first and last stages may both be absent—that is, a 
man may be suddenly struck down with collapse, and 
as suddenly be restored to perfect health, without 
passing through the stage of fever. The writer has 
observed this phenomenon in its completeness, again 
and again, on the coast of Siam; but it is of ex- 
tremely rare occurrence in Europe or the United 
States. “The poison of Cholera, in Great Britain,” 
says Dr. Kirk of Scotland, ‘does not seem suffi- 
ciently energetic to destroy the constitution in a 
moment, as it is said it sometimes does in India. 
Nature here struggles for emancipation, generally 
for days together, and institutes new actions, and 
various discharges, to relieve herself of her load.” 


TREATMENT OF THE PREMONITORY STAGE. 


This is simple enough—only be prompt. What- 
ever you do, waste no time; for Cholera is the time 
of failing forces, and the tide of circulation that is 
going out, and it waits forno man. You may have 
three days of warning—act as if you had but three 
hours; and from the moment that you take hold 
of what threatens to be a case of Cholera, keep con- 
stantly in view the following indications, in their 
order : 


72 TREATMENT, 


I. To allay irritation in the nervous expansion of 
the stomach and bowels. 

II. To excite the vascular system, and to restore 
fluidity, motion, and heat to the blood, by restoring 
the impaired nervous vitality. 

III. To reanimate the suppressed secretions. 

IV. To obtain healthy evacuations from the bow- 
els and kidneys. 

V. To control and moderate reaction, and ob- 
viate congestions, local determination, or organic 
inflammation. 

When the patient comes under treatment in this 
stage of the disease, before the pulse and animal 
heat have failed, his recovery may be calculated 
upon with much confidence—especially if he be 
young, of vigorous constitution, and with a reactive 
vitality unimpaired by previous organic disease. 
Therefore, while the symptoms are confined to sim-: 
ple diarrhea, nausea, or imperfect vomiting, flatu- 
lence, vertigo, headache, and pain in the abdomen 
or pit of the stomach, thrilling sensations of heat 
through the bowels, and probably occasional cramps 
or quivering in the legs—to any or all of these 
symptoms—send him at once to bed, and insist upon 
strict repose. If he can use a bed-pan for the pur- 
pose of evacuation, so as to avoid rising from his 
bed even for that occasion, so much the better. 
Many persons have experienced the full develop- 
ment of Cholera, and have even died, for having, 
in the beginning, refused to take to the bed for a 
simple looseness ; and a diarrhcea which would surely 


TREATMENT. 73 


have degenerated into Cholera has often been cured 
by the mere repose and warmth of the bed. Keep 
him warmly covered, and make him wear a flannel 
band around his belly. An excellent application to 
the abdomen is a bag filled with ashes, or bran, very 
warm, and often changed. At the same time, if the 
weather be cool, let the temperature of the apart- 
ment be kept moderately high. Administer inter- 
nally nothing, as yet, except half an ounce of castor 
oil with 25 drops of Jaudanum, in a cup of strong 
coffee. 

But if the nausea and diarrhcea continue—espe- 
cially if the oil and coffee are rejected—if the pain 
in the abdomen and pit of the stomach becomes 
more distressing, and the vertigo and flatulence, 
and thrillings of heat in the bowels increase, apply 
a large mustard poultice over the whole surface of 
the abdomen, so as to cover the pit of the stomach, 
and administer a draught consisting of a tablespoon- 
ful of salt, dissolved in a large tumbler of warm water. 
If the pulse has begun to sink, the extremities to 
grow cold, and the cramps to be painful, repeat the 
salt and water, doubling the quantity of salt, and 
adding a teaspoonful of red pepper. This will act 
as a free emetic, and will probably bring up a con- 
siderable quantity of dark bile—perhaps thick and 
vitiated ; but that will depend, to some extent, on 
the intensity of the attack. The administration at 
this time of an active emetic is in accordance with 
the admirably expressed views of Dr. James John- 
son, who says: 

4 


74. TREATMENT. 


‘Of all the means which nature or art can bring into 
operation, the act of full vomiting is the most powerful in 
driving the blood from the trunk to the capillaries—from 
the internal organs to the periphery of the body. It is 
also the most universal excitant of secretion in every gland- 
ular structure of the living machine. Nausea and retching 
are quite different in their effects from the operation of full 
vomiting; for they depress the power of the heart and 
nervous system, and prevent the blood from flowing to the 
surface; while full vomiting impels the circulation with 
such force into the superficial vessels that it is extremely 
difficult to stop the flow of blood from the orifice of a vein ~ 
during vomiting. I have seen the blood come from a vein, 
under such circumstances, with all the character, or at 
least the appearance, of arterial blood.” 


But this is the only time when it is surely an 
advantage to administer emetics; in the more ad- 
vanced stages they are of doubtful propriety. 

If these measures prove ineffectual—if the pulse 
continues to sink, and the surface to grow colder, 
if the cramps increase in violence, and the dis- 
charges from the bowels are losing their natural 
feecal color and odor, and assuming the ‘‘ rice-water ” 
characteristics, it is quite time to begin with stimuli 
—equal parts of laudanum and spirits of camphor, 
a teaspoonful in half an ounce of brandy every half 
hour; for collapse is almost upon you, and you have 
no time to spare; but don’t have recourse to stim- 
uli until the pulse is decidedly sinking, and the sur- 
face growing cold ; then nature needs them, and their 
force is expended where it is needed. 


TREATMENT. wo 


Cloths wrung out in hot water, and laid on the 
abdomen, are very useful in alleviating the pain, or 
any griping that may attend the diarrhea. 

The following is an excellent formula for pills to 
arrest the diarrhea, especially in persons destitute 
of the comforts and conveniences of life, or whose 
occupations keep them stirring or exposed: 


R. Pulv. Opii—er. xv. 
Hydrarg. Submur.— 3 j. 
Pulv. Bacc. Capsici— 3 ij. 
Confec. Rosee—q. s. 

So as to make 40 pills. 


One to be given every two hours, till the diar- 
rhea is checked. They produce a degree of consti- 
pation, which, if necessary, may be removed on the 
second day by any mild laxative. Physicians will 
find it convenient to carry a box in the pocket, for 
the way-side emergencies of a cholera invasion. In 
a few cases, not diarrhea, but obstinate constipa- 
tion prevails, “after a longer or shorter duration of 
which the disease suddenly appears.” For these, 
castor oil, or rhubarb and magnesia, assisted by in- 
jections of warm water, are to be preferred, whilst, 
from first to last, drastic purgatives are to be strong- 
ly deprecated. Active friction of the abdomen with 
warm flannels, or the bare hand, will materially pro- 
mote the action of the laxatives. 

If the patient has already begun to suffer from 
thirst, toast-water, beef-tea, and thin sago, are the 
safest. drinks—a little at a time; and the diet should 


76 TREATMENT. 


be confined to chicken and mutton-broth, and well 
boiled rice. 

Should recourse be had to the stimuli, of brandy, 
laudanum and camphor, their action should be sec- 
onded by the application of steady dry heat, and en- 
ergetic and persistent friction. Let the upper and 
lower extremities be surrounded with bags of heated 
ashes, bran or sand, or with hot bricks and bottles 
of hot water, wrapped in woollen cloths; heat com- 
mon platters of metal or earthenware, and lay them, 
wrapped in flannel, on the pit of the stomach and 
the abdomen ; at the same time, assiduously rub the 
legs and arms with warm flannels, sprinkled with 
dry mustard. 

So much for the treatment of the premonitory 
stage, down to the point where it begins to pass 
into collapse. The prompt and vigilant application 
of these various measures will infallibly ward off the 
“cold blue”. stage, in ninety cases out of a hun- 
dred. In this place, by the by, we remember the 
importance of enjoining cheerfulness, as far as may 
be, in the attendants and surroundings of a patient 
in the premonitory stage of Cholera. 


TREATMENT OF THE STAGE OF COLLAPSE. 


We will now suppose that all our efforts to shield 
the patient from the icy grasp of true Cholera have 
been unavailing, and that he is fast sinking into com- 
plete asphyxia—his pulse no longer to be felt, his 
skin brown or leaden, and doughy and clammy and 


TREATMENT. 77 


cold, like that of a dead body, his tongue cold, even 
his breath cool, his features pinched and shrunken, 
his expression anxious and woe-begone, his fingers 
and toes withered and puckered, his eyes sunken, 
his voice hoarsely, piteously whispering,—wrenched 
and torn with cramps, and maddened with thirst ; it is 
a frightful picture; our readers should be shockingly 
familiar with it by thistime. Well then, what now ? 

Courage and Perseverance /—Heroic treatment 
and indefatigable pertinacity !—You have this dread- 
ful encouragement, that the case is clearer than it 
was before, the ‘situation ” simpler ; you know your 
foe now, and you confront him face to face ; you 
have nothing to hope for from nature, and nothing 
to fear from experiment, and noghing to lose; 
you may cripple or exhaust your patient in 
striving to save him, but the Cholera, if it break 
down your guards, will surely slay him outright. It 
is a fair stand-up fight between you and your giant ; 
your patient’s vital subsistence, and your own scien- 
tific ammunition, are running very low; if you 
waver or parley, you are lost. Remember—that 
“ the organs, during the collapse, probably owing to 
deficient vitality, often give no indication of having 
been acted upon by repeated doses of certain power- 
ful medicines, which, under other circumstances, 
would have produced the most decided effects.” 
But forget the “ therefore ”’—that it is suggested (by 
some irresolute and short-sighted practitioners, who 
do not recognize an analogy even when it is held be- 
fore their eyes) “that this temporary insensibility 


"38 TREATMENT. 


of the system should not inculcate the administration 
of such quantities as could, by accumulation, when 
- the organs begin to recover their vitality, give rise 
to unfavorable results.” If you administer to aman 
who has been bitten by a rattlesnake, two or three 
quarts of whiskey or apple brandy, you have no fear 
that he will die “‘ dead drunk,” as soon as he begins 
to recover his vitality; nor do you find it difficult to 
understand why, in cases of Cholera that have been 
treated with free doses of calomel in quick succes- 
sion, salivation is so rarely produced. 

Now, then, is the time to bring all your forces 
into action, and engage them all together, with 
intrepidity and éan. Begin by giving a large 
enema—from three to four pints of as hot water as 
the hand can bear, with six ounces of brandy, and 
two drachms of laudanum. At the expiration of an 
hour, withdraw this enema by a tube introduced into 
the rectum—it will come off quite cold—and imme- 
diately throw in another, without the laudanum and 
brandy. At the same time administer by the 
mouth, every half-hour, the equal parts of landanum 
and camphor, a teaspoonful in half an ounce of 
brandy, already prescribed. One hour after the last 
injection of hot water alone, repeat it—this time 
adding the brandy and laudanum—and so on by 
alternate hours. Between the doses of landanum and 
camphor, give five grains of QUININE, in any mode 
of administration least disagreeable to the patient ; 
if it be immediately rejected, immediately repeat it. 
If the means of injection are not at hand, double 


TREATMENT. 79 


the doses of camphor and laudanum, until some 
simple apparatus can be procured; though it is rea- 
sonable to expect that, in time of Cholera, every 
family not absolutely destitute will be provided 
_with one, and that no physician will go abroad 
without it; it should also be in the power of every 
police officer to furnish one at the shortest notice. 
Still, though a great advantage, and the best of all 
possible modes for applying heat, the enema is not 
imperatively indispensable, the patient’s life does not 
depend upon it; and if you cannot Inject, you may 
make the double doses of laudanum and camphor 
serve your purpose, especially if you have your great 
gun, the Quinine, engaged. If he rejects the lauda- 
num and camphor, give him a grain and a half of dry 
opium every hour, until he ceases to vomit. 

All this while it is to be presumed that you have 
been pursuing your external treatment with re- 
doubled assiduity and care; that your bricks, your 
bottles of water, your bags of ashes or bran or sand, 
are in their places and kept hot, worsted stockings, 
filled with hot sand constituting a simple and effec- 
tive appliance; that you are keeping your patient in 
a strictly horizontal position, and in as complete 
repose as may be practicable; that you have his 
chest and arms clad in thick flannel, and his abdo- 
men and thighs and legs covered with sinapisms, and 
that you are applymg cloths wrung in very hot 
water to his feet ; or that you are vigorously rubbing 
him with dry warm flannels wherever and whenever 
you can get at his legs or arms or trunk; that you 


80 TREATMENT. 


cause his bed-covering, and his warming appliances, 
to be carefully replaced as often as, in his restless, 
tossing agony, he may throw them off; and that you 
have made your assistants sensible of the impor- 
tance of avoiding all unnecessary disturbance of the 
patient, and of confining him to the horizontal posi- 
tion until the heart shall have recovered its action, 
by reminding them that an erect, or even half erect 
position during the collapse, has been often observed 
to produce instant death; indeed, any muscular 
movement is more or less dangerous. For this rea- 
son alone, the use of the warm bath, once in decided 
favor, isto be positively condemned. In its time it 
probably killed five cases for every one it saved; 
baths of all kinds are painful and dangerous. 

The patient ought never to be left, for a moment, 
without an attendant firm enough to guard and con- 
trol him, and sufficiently well instructed to be capa- 
ble of acting according to circumstances, and taking 
advantage of every change. ‘The application of 
evaporating liquids, or indeed of any moisture, to 
the general surface, should be forbidden, for obvious 
reasons. When the frictions with dry warm flannel, 
powdered with mustard, can be maintained by four 
persons rubbing all at once the whole surface of the 
body, the advantage is great. Mustard plasters 
should be applied to the spine, when that can be 
done without disturbing the patient too much; and 
the vomiting is often allayed by linen cloths dipped 
in hot water and laid on the pit of the stomach. 
When the cramps are excruciating in the muscles of 


TREATMENT. 81 


the arms and legs, the roller bandage, firmly applied, 
will often afford decided relief; the patient com- 
monly cries out for extension and pressure, “ strong 
pressure,” there. For that inappeasable fiend of 
thirst, the sufferer may suck or swallow whole, smail 
lumps of ice, the size of a hickory-nut; no drink will 
afford him such grateful relief; if you are compelled 
to give him cold water, it should be colored with 
brandy, and slightly acidulated, and he should be 
allowed to sip it only. 

And now, if you must be afraid, be afraid of the 
Collapse, and not of your remedies. 

Not of the stimulants—for if you have understood 
what we have so conscientiously and particularly en- 
deavored to demonstrate, as to the true nature of 
the disease, and the pathological procession of the 
phenomena, any defence of the stimulant treatment 
is unnecessary; and if you have not understood that, 
such a defence were useless. 

Not of the opium—for the vomiting, the purging, 
the cramps—originally honest efforts of nature to - 
relieve the engorgement and congestion, and restore 
the secretions, by giving a new impulse to the circu- 
lation, and new energy to the insensible nervous ex- 
tremities, having failed of their intention, have now 
become simply exhausting, and must be stopped. 
And who needs an argument to prove that that may 
best be done by an astringent, an antispasmodic, an 
anodyne, astimulant, allinone? Only, give enough. 
When the Cholera first appeared in Russia, the 
French Government sent an agent to St. Petersburg 

4% 


82 TREATMENT. 


to investigate the nature of the disease; and he 
wrote: “ The brilliant success mentioned by English 
physicians has been of very rare occurrence, and due 
only to the very large doses which they have had the 
courage, or rather the temerity, to administer.” 
Remember, that collapse almost never comes on till 
after profuse serous discharges from the bowels. 

Not of the Quinine—for of all the medical agents, 
whose aid fair science has invoked for the relief of 
collapsed and congested, stagnant and dried-up 
humanity, there is not one more direct, more consis- 
tent, more clear in its great office of distributing and 
equalizing the circulation, and leading the vital cur- 
rent back from its bursting dams to its remote, 
deserted channels, than this simple, faithful, noble 
tonic. Moreover, you have, in the asphyxia of 
Cholera, a true tonometer. Watch those puckered, 
blanched, and withered fingers, and ply your quinine 
without fear; for so long as they remain withered, 
blanched, and puckered, you may be sure that the 
‘peculiar virtue of the drug fails before the paralyz 
ing potency of the poison, with the inertness of 
bread pills; but so soon as they begin to plump out 
rosily with the returning genial heat— 


Its faintest, feeblest stir 
Slow-spreading, strengthening long, at last 
Vibrating full in them,”— 


then stop; so you will have nothing to fear from 
“‘the accumulative effects of the drug ;” on the con- 
trary, you will probably find the consecutive fever 


TREATMENT. 83 


mildest and briefest in those cases of which the col- 
‘apsed stage has been treated with quinine—as from 
she analogy of its modus operandi in intermittent 
fever, you might expect. 

It has even been argued in objection to the treat- 
ment by quinine, that neither that “nor any other me- 
dlicine” can produce any effect whatever in the col- 
lapsed stage, because the absorbents are paralyzed. 
But it must be evident that the remedial measures 
here recommended to precede, accompany, and co- 
operate with the quinine, forcibly tend to revive the 
function of the absorbents, by promptly restoring 
vitality to that portion of the nervous system from 
which such functions are derived. 

Of no disease in the whole dire catalogue is it truer 
than of Cholera, that “while there’s life there’s 
hope.” Keep on saying ‘‘ Never say die,” with the 
pertinacious iteration of Barnaby Rudge’s raven. 
Stick fast to your patient, and fight for him, in spite 
of extreme unction, almost in spite of a charnel odor ; 
and never give him up until the coffin-lid is screwed 
down. Itis not easy to say just when people do die, 
according to “ Crownners’ ’quest law,” in Cholera 
asphyxia; for they are often colder and more insen- 
sible than any dead man some hours before they give 
up the ghost, and sometimes they are warmer than 
many a living one, some hours after. At the Mission 
San Dolores, near San Francisco, where many cases 
of Cholera occurred in 1849, the writer saw a living 
Mexican “ laid out.” 


84 TREATMENT. 


TREATMENT IN RHACTION. 


Unless your patient’s constitution has decayed with 
age, or been broken by previous disease or de- 
praved habits, he will, in a few hours, have rallied 
under the treatment here prescribed. Now is the 
time to bring up your “mercury ” reserve. As soon 
as the pulse returns to the wrist, and begins to 
acquire volume and strength—as soon as the natural 
warmth and color begin plainly to return to the skin, 
and the spasms to abate—at once, without waiting 
for other signs of reaction, stop the injections, double 
the intervals between your doses of quinine, and be. 
tween those of laundanum and camphor; that is, that 
there may be an hour from quinine to quinine, and 
an hour from laudanum to laudanum—and tmme- 
diately give twenty grains of calomel. If, at the 
expiration of two hours, the evacuations have not 
become bilious and frecal, repeat the dose. If they 
have, stop the quinine, laudanum, and camphor, and 
give ten grains of calomel; which should be followed 
up, at the expiration of two or three hours more, 
with a full dose of castor oil. If by this time he has 
passed urine, and dropped into a restful slumber, as 
will probably be the case, your patient is saved; the 
Cholera has passed, and what remains is either com- 
mon continued fever, or direct convalescence. 

In June, 1852, Tobee, tindal of the Malays, on 
board the Hon. East India Company’s war-steamer 
Phiegethon, went ashore at Aracan, at 9 in the 
morning, in perfect health. At 1 oclock he was 


TREATMENT. 85 


brought back completely collapsed—cold and blue. 
The treatment employed was precisely that which 
has been prescribed in these pages, especially as to 
the brandy, camphor, quinine, and calomel. At 7 
o’clock the sane evening the natural heat and hue 
had returned to the skin; after passing considerable 
quantities of thick, black, vitiated bile, his stools had 
become fecal and nearly natural; he had passed 
urine, and was sleeping quietly. Twenty-four hours 
afterwards he was on deck, comparatively well, and 
on the third day he was discharged from the sick- 
list at his own request. He was a man of about 
twenty-five, with an unimpaired constitution, and of 
great personal strength and courage. He had no 
fever. 

This case was followed by several others—all 
natives, and some of them strictly abstemious. -Ad/ 
were collapsed, all took the quinine, none had the 
Sever, and ail recovered. Among the European por- 
tion of the crew not a case occurred; notwithstand- 
ing that many of these got drunk as often as the 
opportunity offered, and all took their regular daily 
allowance of grog. 

In the rallying stage it is important to watch the 
changes, to prevent recurrence of collapse on the 
one hand, and to ward off congestions of the head and 
viscera on the other. The first is averted by repose 
and external warmth, and by giving warm arrow- 
root in moderate quantities; the second, when the 
indications are threatening, by small doses of calomel, 
and castor oil, with acidulated drinks. 


86 TREATMENT. 


TREATMENT IN THE STAGE OF FEVER. 


The eminent Mr. John Fyfe, of Newcastle, Eng- 
land, who in 1831 attended 579 cases of Cholera, 
used to say that the duration of the consecutive . 
fever was commensurate with the duration and 
severity of the collapse, and not much dependent on 
the kind of remedies employed. This is certainly 
far from being true of the Indian form of the disease, 
especially of those cases which have been treated 
with quinine; and even in England, and in this 
country, a very mild case sometimes precedes a 
dangerous fever; and sometimes after the severest 
collapse there is no fever at all. In England, under 
certain circumstances, the fever, unless strictly 
watched, proved more frequently fatal than collapse 
itself, though the symptoms were described as differ- 
ing but little, if at all, from those of ordinary typhus 
—except, perhaps, in the greater rapidity with which 
they ran to a fatal termination. 

There is apt to be much giddiness, pain in the head, 
and stupor. If the case is a mild one, mustard 
poultices applied to the neck. will relieve the head,— 
and to the epigastrium, the stomach. Should there 
be constipation, it may be corrected with simple 
laxatives. Ifthe cerebral oppression is very serious, 
the back of the neck should be blistered, and the 
head shaved and kept cool with wet cloths, or even 
with ice. Small doses of calomel and castor oil (as 
in a preceding paragraph) should be given; and 
great care should be observed to avoid errors of diet 


TREATMENT, 87 


The congestion which threatens the head is the chief 
danger, and it will often be necessary to precede the 
blisters (which are sometimes applied to the scalp, 
and sometimes also to the calf of the leg) by leeches 
behind the ears or on the neck, 


So much for a rational and successful treatment 
of Cholera, from first to last. Whoever may be 
disposed to take exception to the method, will surely 
not deny it the merit of simplicity, procurability, 
and adaptability. All the means and appliances are 
within the reach of the poorest man; and in the 
absence of a physician, any person of fair intelligence 
and common sense can use them. 

Children, with their fresher constitutions and their 
purer habits—and, above all, their minimum of sus- 
ceptibility to the influence of panic—are in infinitely 
less danger from an invasion of Cholera than their 
more corrupt and conscience-stricken elders. When 
attacked, they suffer more from oppression of the 
brain than adults: and their consecutive fever al- 
most always assumes the shape of Hydrocephalus. 

Relapse in Cholera—not very common—should be 
treated on the same principles as the original attack. 


XI. 
_ IS CHOLERA CONTAGIOUS? 


Wiruin the limits of a compact practical treatise, 
we cannot, with profit to the reader, and for the 
attainment of that handy usefulness which, from the 
first, has been our single aim in the preparation of 
these papers, indulge our zeal by engaging in the 
irrepressible conflict which this vexed question 
seems to involve—a wordy, windy warfare, which 
will not cease to be waged so long as straight facts 
can be wrenched and twisted to the needs and tricks 
of mere wrangling ; so long as medical Ephraims are 
joined to their hobby-idols; so long as those who 
have the power to establish and enforce quarantine 
regulations find their personal advantage in the 
exercise of that authority. But since it is by ‘‘ both 
houses” conceded that if Cholera is contagious, the 
most rigid quarantines that sagacity and experience 
can devise, and firmness enforce, are imperatively 
demanded for the protection of populations; and 
that if, on the other hand, it zs noé contagious, such 
quarantines are not only useless, but infinitely per- 
nicious, by their tendency to plunge in extreme 
misery the hundreds of families and thousands of 
individuals who are dependent upon the commerce 
they suddenly blockade, and the labor they sud- 


IS CHOLERA CONTAGIOUS ? 89 


denly discharge; and so to encourage those condi- 
tions which most potently invite the disease, 
while, at the same time, they frighten off the 
humaner agencies which alone can prevent, con- 
quer, or mitigate it; therefore, we prefer to take 
this question sharply by the throat, and to declare 
our positive conclusion, deliberately reached through 
careful examination and comparison of all the evi- 
dence brought forward on both sides, as well as 
from unusual opportunities of observation in the 
very laboratories and hot-beds of this atmospheric 
poison, that not a single case—well attested, and 
clearly, completely Gemonstrated—of Cholera trans- 
mitted by contact alone—with the person, clothing, 
excretions, or effluvia of another “ case ”—has ever 
yet been cited; and this we say in full knowledge 
of all the guast “facts and proofs” elaborated by 
the glorious minority of contagionists, whose doc- 
trine manifestly tends, first, to make victims, and 
_then to leave them prostrate and unbefriended ; 
/ for Panic nurses Cholera, and the doctrine of Con- 
\. tagion patronizes Panic. 
~ It is safe to say that in India ninety-nine out of 
every hundred physicians of any professional respect- 
ability utterly flout, as a thing preposterous, this 
“ Contagion” scarecrow, and the majority of them 
regard it as a nuisance sufliciently noxious to be 
abated by law. On this subject the present writer 
conferred, during two years, with numerous medical 
officers of the most accomplished attainments, and 
complete experience, in the service of the East India 


90 IS CHOLERA CONTAGIOUS ? 


Company, as well as with many of the Surgeons of 
the Royal Navy, attached to the China and India 
Squadrons; yet he cannot now remember one 
who did not scoff the notions of the Contagion- 
ists; and when we consider that these can, never- 
theless, show upon their rolls here and there an 
eminent name, we can only wonder at the common- 
ness of crotchets and the uncommonness of common 
sense. 

In this connection we cannot do better than quote 
from the very thoughtful treatise of Dr. Brigham: 


“That some cities and fortresses, which established rigor- 
ous quarantine regulations, have escaped the disease, is 
very true; but it is also true that other places, immediately 
adjoining those which were attacked, have escaped, not- 
withstanding that every precautionary measure had been 
omitted. It is further true that numerous countries, cities, 
and fortresses have adopted and enforced the most severe 
preventive regulations—that they adopted them early 
and enforced them with rigor—and yet the disease ap- 
peared among them. All that quarantine enactments can 
do towards preventing the spread of a disease from one 
country to another, has been done in Russia, Austria, and 
Prussia. 

“In Russia immense lines of troops were drawn, to 
arrest its progress; St. Petersburg was entirely surrounded 
by cordons sanitaires ; but all these regulations, enforced by 
a powerful and despotic government, were unable to pre- 
vent the approach and the spread of Cholera throughout the 
Russian Empire. The efforts of Austria were equally un- 
availing, for in a short time the disease passed her triple 
cordons and invaded the country from Poland. Prussia 


IS CHOLERA CONTAGIOUS ? 91 


employed sixty thousand of her best troops to enforce her 
rigorous restrictions, and travellers bear testimony to the 
severity with which they were enforced. And what has 
been the résult? (turning to The American Journal of Med- 
ical Sciences for May, 1832)—‘ An immense expenditure of 
money, the suspension of commerce, a stop put to industry, 
multitudes deprived of the means of acquiring subsistence, 
and whole families rendered favorable subjects for the disease ; 
but no stop to the extension of the disease—on the con- 
trary, its progress was rendered more fatal, As an instance 
of this, Breslau may serve as an illustration and a warning 
to other cities. That city contains ninety thousand inhabi- 
tants—active, commercial, and industrious, many of them 
manufacturers and artisans. A quarantine of twenty days, 
with the difficulties almost insurmountable which it en- 
tailed, was established at the borders of the province, and 
maintained with a rigor which might serve as a model to 
other nations. But in the midst of this apparent security, 
a woman living in a damp part of the town was attacked 
by the Cholera, and in a few days the disease spread. The 
most minute researches on the part of the public authori- 
ties could not discover any communication between the 
woman and any stranger or goods suspected of being infected. 
But when the disease spread, the authorities saw too late 
the deep injury their sanitary measures had. inflicted.’ 

“Taught by lamentable experience, Russia and Austria 
and Prussia have withdrawn their cordons, and acknowl- 
edge not only their inutility, but that they are productive 
of immense evils. Indeed, all the nations of Hurope are 
abandoning severe quarantine regulations, and it is to be 
hoped that the cities of the United States will not adopt 
them, but place all their reliance, for the prevention of the 
disease, ori the removal of those causes which in all coun- 
tries have appeared to produce it.” 


92 IS CHOLERA CONTAGIOUS ? 


With such darkness as that of the St. Peters- 
burgs, Moscows, and Breslaus of imbecility before 
us, is this a time to slip on the goloshes of Conta- 
gion, as Hans Christian Andersen would say, and 
step out into the Middle Ages of Fumigation ? 

To. what purpose, save to set up the mare’s nests 
of certain professional Pickwickians, is all this 
tedious bewilderment of wrangling, when at every 
turn the earnest and honest inquirer encounters 
such facts as these that follow? We shall take 
them as we find them, plainly and sturdily arranged, 
in the excellent work already quoted; and we con- 
tent ourselves with asking any reader who may 
have previously qualified himself to answer, by 
learning from a school-boy’s “‘Speller and Definer” 
the meaning of the word Contagion, whether any 
one of them could under any circumstances be true 
of a disease not distinctly non-contagious ? 

I. The great numbers attacked simultaneously, 
and who had previously had no intercourse with the 
sick—a fact which all writers on Cholera admit— 
cannot be accounted for without supposing the dis- 
ease to be simply epidemic. 

Ii. The general exemption from the disease of 
medical and other attendants on Cholera cases: 

1. Dr. Jameson says that of between 250 and 300 
physicians engaged in Cholera practice in Bengal, 
only three took the disease. 

2. At Bombay none of the hospital attendants 
were attacked, though they were assisting the pa- 
tients day and night. 


IS CHOLERA CONTAGIOUS ? 93 


3. The Madras report shows that, in the hospital 
of the Royals, only one out of 101 attendants was 
attacked, and at the receiving hospitals for Cholera 
patients at Trinchinopoly, St. Thomas du Mount, and 
Madras, the attendants were numerous and some- 
times shared the same bed with patients; yet noé 
one took the disease. 

4, At Berhampore none of the native attendants 
on the Cholera hospitals were affected. 

5. A letter addressed to the Medical Council of 
Moscow, by eight chief physicians to the hospitals 
of Astrakhan, says: “We have all, without any 
precaution, touched and rubbed the sick; and we 
have daily visited the hospitals crowded with 
Cholera patients, where we have respired their 
breath; yet we have neither contracted the disease 
nor conveyed it to our families. The attendants who 
nursed and applied frictions to the patients—who 
put them into baths, changed their linen, and per- 
formed other offices for the sick—remained free 
from Cholera. In the military, as well as in the 
civil hospitals, the linen and clothes of Cholera pa- 
tients were transferred to other patients without 
being previously fumigated or ventilated ; and, never- 
theless, those who wore those garments did not be- 
come affected with Cholera. Several nurses and 
mothers, having Cholera, suckled their children both 
during and after the disease; yet the latter were not 
attacked.” 

6. Dr. Lefevre, physician to the British Embassy 
at St. Petersburg, reports as follows ; 


94 IS CHOLERA CONTAGIOUS ? 


“In private practice, among those in easy circumstances, 
I have known the wife attend the husband, the husband 
attend the wife, parents their children, children their parents 
—and in fatal cases, where, from long attendance and anxi- 
ety of mind, we might expect the influence of predisposition 
to operate ; in no instance have I found the disease com- 
municated to the attendants,” 


7. During the prevalence of the epidemic at Mos- 
cow, 587 persons, affected with Cholera, were admit- 
mitted into a hospital where there were already 860 
patients laboring under other diseases. Vot a single 
one of the latter took the Cholera. 

Dr. Zudkoff, of Moscow, who had formerly been 

a Contagionist, declares that he saw, to his astonish- 
ment, that all the attendants and all the soldiers 
handled the sick, and supported their heads while 
they vomited, without using the least precaution, 
and without contracting the disease. 
-. 8. Mr. Searie, who attended a very large number 
of patients in Warsaw, where he had charge of a 
hospital for the poor, writes that not one of the at- 
tendants, not one of the nurses, not one of those who 
handled the dead, fell a victim to the scourge. 

9. In Berlin, 409 houses were visited by the epi-. 
demic, and in 273 of these only one individual in 
each house was affected, while in the remaining 136 
four or five suffered in each. Such is the density of 
the population in the quarters of Berlin so attacked, 
that the census assigns 4,200 families, with an ave- 
rage of four persons to each family, to those 409 
houses, being an aggregate of 16,800 residents who 


IS CHOLERA CONTAGIOUS ? 95 


lived in immediate contact with Cholera. Of this 
mass, only 803 were stricken with the disease, or 
about one in 18 persons. 

10. In the Marine Hospital of St. Petersburg, of 
forty-three attendants on Cholera patients, not a 
single one was affected ; and in the temporary hos- 
pital in that city, of fifty-eight attendants, only one 
was attacked, and he after drinking kwass while 
very warm. 

11. Those engaged in post-mortem examinations 
of Cholera cases have not been attacked by the dis- 
ease. Such examinations have everywhere been 
made without any precautions, and with perfect 
impunity. 

12. Dr. Foy at Warsaw, and ten others, inoculated 
themselves with the blood of Cholera patients, tasted 
their dejections, and inhaled their breath, without 
receiving the disease. 

13. As to the capability of merchandise to con- 
vey, and afterwards to communicate the infectious 
germ of Cholera, the Central Board of Health, in a 
communication to the Privy Council, remark: 


“There is, perhaps, no question in the whole range of 
sanitary police on which so many and such irrefragable facts 
can be brought to bear as on this—derived, too, from the 
most authentic sources. 

“Seven hundred and thirty ships, laden with hemp and 
flax, from infected ports of the Baltic, arrived at the differ- 
ent quarantine stations in this country between the Ist of 
June and the 3lst of December, 1831. Many vessels also 
arrived laden with wool and hides; yet not a single case of 


96 IS CHOLERA CONTAGIOUS ? 


Cholera occurred among any of these ships outside of the 
Cattegat sea, nor among the people employed in opening 
and airing their cargoes in the lazarets. At the hemp and 
flax wharf of St. Petersburg, where several thousand tons 
of these articles arrived during the spring and summer from 
places in the interior, where Cholera existed at the time of 
their shipment for the capital, the persons employed in 
‘bracking’ or sorting, and who generally passed the night 
among the bales, did not suffer so early in the season, nor 
so severely, as other classes of the general population. The 
same observation holds good with respect to all the rope- 
walks of St. Petersburg and the Imperial manufactory of 
linen cloth at Alexandrofsky, where all the yarn is spun from 
flax bracked and hackled on the spot” 


14. Down to the 29th of February, 1832, Mr. 
Aspinwall, American Consul at London, reported to 
this Government that only one medical practitioner 
had died of Cholera in England, although at a mode- 
rate computation one thousand or more had been in 
constant attendance on Cholera patients. And, ac- 
cording to The Medico-Chirurgical Review, for 
April, 1832, not a single medical man was affected 
by the Cholera in Sunderland, Newcastle, or Gates- 
head. 

When the Cholera prevailed in its most virulent 
form among the armed vessels and transports of the 
East India Company’s fleet, in the waters of Tennas- 
serim and Pegu, in 1852, no case occurred among the 
medical officers or hospital attendants. At that time 
the writer, having medical charge of a war-steamer, 
freely handled the persons and clothes of Cholera 


IS CHOLERA CONTAGIOUS ? 97 


patients, inhaled their effluvia, and mingled his 
breath with theirs, with the impunity he expected. 
So likewise did his assistants. No precautions 
were taken against contagion, because contagion 
was never thought of among men who annually re- 
newed their acquaintance with Cholera. We be- 
lieve that physicians and nurses are, ceteris paribus, 
less liable to the disease than other classes of per- 
sons, because, by constitution as well as habit, per- 
haps, they are less liable to that sort of anxiety and 
alarm, because in the midst of the disease their 
minds are actively and wholesomely employed, and 
because they are continually impressed with the 
importance of hygienic care, and necessarily ae 
to the practice of it. 

Intelligent and impartial observation has erected 
an iron-clad wall of proof against which the Conta- 
gionists pop their small shot in vain, and on the 
face of which the honest medical inquirer may read 
these truths, for a law to his professional life: 

~ Cholera is strictly an epidemic, existing by force 
of a mysterious poison diffused through the atmos- 
phere. Whether the influences which produce this 
poison are “telluric,” “ electro-magnetic,” or “ ani- 
malcular,” we know no better now than we did 
fifty years ago. 

Cholera moves in the form of a vast volume or field 
of such poisoned air. Its rate of progress is com- 
paratively uniform, and its track not more eccentric 
than may be accounted for by the influence of pre- 
vailing winds. 

i) 


pe 


98 IS CHOLERA CONTAGIOUS ? 


As soon as it reaches any given place, all the per- 
sons residing in, arriving at, or passing through, 
that place, who may be predisposed by certain con- 


3 ae hereinbefore stated, become the selected 


_objects of its attack, however widely they may be 


scattered, and without regard to their possibilities 


—of communicating with each other; it is sufficient 


wre 
v or New York in 1848, “although it had been intro- 


that they are included in the Choleraic atmosphere. 

Cholerais never brought; ¢¢ comes. If passengers 
sailing from a port of France, where the epidemic 
prevails, arrive in an American port, whither it has 
not yet come, bringing with them the germs of the 
disease alive in their own systems, those germs will 
not grow and spread in the new and healthy air, but 
will wither and die out for want of their natural 
pabulum—the Choleraic atmosphere. 

But if that atmosphere accompanies them, then 
the germs will flourish and be propagated. This is 
why the Cholera did not extend to London in 18381, 


duced, and persons had been exposed to its infec- 
tion.” The cases had been brought, but the epi- 
demic had not arrived. On the other hand, “ 

spread like wildfire in Paris, in 1832,” because the 
epidemic brought its own cases along with it. But 
the presence of the Choleraic atmosphere is an 
‘essential condition of the spread of Cholera. With- 


tS it, a few isolated cases of aggravated Cholera 


Morbus, in individuals rendered peculiarly suscepti- 


ble and sympathetic by their local and personal ac- 
cidents, are the worst that need be feared, and we 


IS CHOLERA CONTAGIOUS ? 99 


believe that such examples of Cholera Morbus, oc- 
curring during the prevalence of an actual epidemic, 
constitute a large proportion of the whole number 
of cases counted as true Cholera. Upon a prepared 
nervous system, it is most natural that the fiercer 
disease should beget its kind, even though the pro- 
geny may be of weaker powers. 

All attempts to prove that the disease was im- 
ported into Sunderland and England, in 1831, failed ; 
and the opinion that it was not imported at all 
became very general, not only at Sunderland, but 
throughout England, and especially among the 
members of the medical profession. 

On the 28th of April, 1832, at the last meeting 
for that session of the famous Westminster Medical 
Society (the members of which, by their profound 
learning and their intimate acquaintance with the 
disease, were as well qualified to decide this impor- 
tant question as any other body of men in the 
world), the prolonged discussion ‘“‘on the nature, 
character, and treatment of Cholera Morbus” was 
concluded by the adoption of the following resolu- 
tion, Dr. Granville moving, and Dr. James Johnson 
seconding : 


“That the Westminster Medical Society, having devoted 
the uninterrupted space of six months to the serious and 
dispassionate consideration of the malady which has been 
prevailing in England since the latter end of September 
last, and especially in the Metropolis, and having heard the 
several arguments, depositions, doctrines, and facts, of the 
many members practically, as well as theoretically, engaged 


100 IS CHOLERA CONTAGIOUS ? 


in that important ioquiry, declare that, in the opinion of 
the majority of the Society, the evidence brought forward 
to prove the said malady to be a contagious disease has 
completely failed; and that every circumstance which has 
come to the knowledge of the Society shows the disease 
in question to have begun, progressed, and ended in the 
ordinary way of every other epidemic disorder: ” 


—that is, a disorder which falls at once upon great 
numbers of people. 

Quarantines to exclude the choleraic atmosphere 
can, therefore, be best appreciated by such as he 
who complained that he had caught cold by sleep- 
ing in the Park with the gate open. 

Says The Medico-Chirurgical Review: 


“Medical men will now see how much they will have it 
in their pywer, when the Cholera comes, to pronounce or 
withhold sentence of desolation upon a community. The 
word Contagion will be the word of doom; for then the 
healthy will fly their houses, and the sick will be deserted ; 
but a countenance and bearing devoid of fear will command 
the aid, and inspire the hopes, that are powerful to save in 
the most desperate cases.” 


XII. 
THE INFLUENCE OF FEAR. 


Ir anything could render Cholera contagious it 
would be the enervating influence of Panic—as when, 
wanting a contagion of its own, it rides on the con- 
tagion of fear. For fear diminishes the nervous 
power, depresses and enfeebles the action of the 
heart, retracts the blood from the extreme vessels, » 
and deranges the secretions. 

“Fear,” says Dr. Falconer (Zreatise on the Influ- 
ence of the Passions on the Diseases of the Human 
Body) “diminishes the power of the heart, and 
enfeebles the pulse—sometimes to such a degree 
that the blood does not flow on opening a blood- 
vessel. Fear also arrests the natural secretions, and 
renders those who are frightened more liable to be 
attacked by contagious diseases.” 

M. Virey (Dict. des Sciences Medicales) says: 
‘Hear produces derangement of the secretions, cold 
perspiration, a recession of the blood from the sur- 
face to the heart, and diarrhcea, with coldness and 
paleness of the skin.” 

Alibert (Physiologie des Passions) says: “ Fear 
is of a contagious nature, and its effect upon the 
body is to produce a retrocession of the blood from 


102 THE INFLUENCE OF FEAR. 


the exterior to the interior, and to derange or sup- 
press all the functions of assimilation.” 

“The tendency of Fear,” says Dr. Brigham, “is 
to produce and spread spasmodic complaints, and. to 
become epidemic during great public calamities. It 
not only disposes a person to be affected by a con- 
tagious disease, but actually produces a disease, with 
symptoms similar to the premonitory symptoms of 
Cholera.” He calls attention to the fact, that an 
individual whose mind is constantly on the alert to 
detect some symptoms of disease of the stomach or 
bowels, who anxiously watches the effect of every- 
thing he eats or drinks upon the organs of digestion, 
will be very certain to create in them a morbid sen- 
sibility, which will be followed by indigestion, diar- 
rhea, or other derangement; and suggests that there 
is great reason to apprehend that many, very many 
cases of Cholera, if not produced by fear alone, are 
ageravated by it to a dangerous degree; and that 
cases of ‘common Cholera” are transformed, through 
the influence of fear, into the malignant and fatal. 
“ At the present alarming time, no duty of medical 
men, and of all those who have influence over the 
faith of others as regards the epidemic, seems more 
imperative than that they should steadily endeavor 
to quiet public alarm, and constantly abstain from 
creating any fear about the prevalence of the disease, 
and its contagious nature. Hundreds will die of 
common Cholera, if they are not assured, and made 
to believe, that the disease which affects them is not 
the Oholera which their fears suggest. In such 


THE INFLUENCE OF FEAR. 103 


cases, every look and question and action of a phy- 
sician is very important. He has it in his power, 
not only to endanger the lives of the sufferers, but 
to spread around a far more dangerous contagion 
than that of Cholera—the contagion of fear ; to drive 
from the bed of sickness the anxious relatives and 
useful attendants, palsy the hand of charity, and 
create in those who are obliged to attend upon the 
sick a disposition to a disease closely allied to, if 
not identical with, malignant Cholera; for the pas- 
sion of fear falls in and unites with the disease, and 
attacks and paralyzes the same organs.” 

A man was once journeying in the interior of 
Turkey, when he met the Pestilence. ‘Where are 
you from?” he asked. ‘From killing 2,000 people 
in Smyrna,” replied the Pestilence. “ That’s a lie,” 
said the man, “I know that you have killed 6,000 
there.” ‘ No,” said the Pestilence, “I killed 2,000, 
and Fear killed 4,000.” 

Adults exhibit a much more lively susceptibility 
to Cholera than children, the apprehensions of the 
latter not being so easily excited. It has been 
observed that the little ones enjoy a remarkable 
exemption from the disease; and its attacks are to 
be looked for, for the most part, among the more 
intelligent children of five or six years and upward, 
who have derived from what they have heard or read 
a depressing anxiety respecting i1t—-as of some invisi- 
ble, mysterious, and fearful calamity, which is steal- 
ing upon them and those who are dear to them. In 
children, fear, like other passions, is soon effaced ; but 


104 THE INFLUENCE OF FEAR. 


it is also more sudden and powerful in them, and far 
more likely to operate dangerously upon their deli- 
cate and susceptible nervous organizations when, by 
their intelligence and imagination, they are in a con- 
dition to entertain it. 


XIII. 
HINTS TO THE SANITARY BOARDS. 


Ir is curious that when the attendants employed 
about Cholera cases in the febrile state are attacked, 
they are never seized with ordinary fever, but with a 
genuine cold blue Cholera. Nothing, therefore, is 
more certain than that persons may arrive in our 
ports apparently laboring under common feverish 
indisposition, who really are suffering under Cholera 
in the febrile stage. 

Dr. Lefevre observed that the epidemic Cholera, on 
its first invasion, baffles all attempts to conquer it; 
but that it gradually loses its intensity, and “toward 
its decline becomes as tractable as other disorders of 
the alimentary canal.” Many other observers have 
particularly noted that the deaths are everywhere 
most numerous, in proportion to the whole number 
attacked, at the commencement of an invasion. 

In crowded, filthy, and ill-ventilated places, where 
the exciting causes are actively combined against the 
health of all who are exposed to their influence, the 
disease takes an apparently infectious character, 
tending still further to propagate it, and aggravate 
the alarm. 

Those who have practised abstinence from the use 
of wine, beer, and ardent spirits, should not have 

5 


* ae , 


rn 


ve 


106 HINTS TO THE SANITARY BOARDS, 


recourse to them in the hope of “ fending off” the 


Sere Nor should those who have habitually and 


reely indulged in the use of them, suddenly and 
completely abstain. In either case the experiment 
is a dangerous one. 

The following remarks of a late writer are espe- 
cially worthy of attention : 


““Eixcesses and extremes of all kinds predispose to 
Cholera. Hxcessive filth does so. So does excessive 
bathing, with a view to extreme cleanliness; for it reduces 
the heat of the body, and debilitates the system. The 
inordinate use of either animal or vegetable food is a predis- 
posing cause. But so, most emphatically, is fasting or 
abstinence, especially as regards animal food, The fearful 
mortality from Cholera in Paris, in 1832, occurred during the 
fastings of Lent. Nothing like it occurred at any other 
period. Ina part of Louisiana, where nearly all the people 
are Roman Catholic, the mortality in a Cholera epidemic 
was quadrupled during and after a three days’ fast.” 


In public and private, cheerfulness should be pro- 
moted by every decent device—on the streets, by gay 
processions—in the parks, by bands of music, and 
moderately exhilarating pastimes—in dwellings, by 
music, games, tableaux, &c.—everywhere, by the 
various attractions of places of rational amusement. 
Public journals should stand with a hopeful and en- 
couraging face between the pestilence and the peo- 
ple, and children and nervous persons should not be 
permitted to read or talk about the Cholera at all. 
Food, clothing, warm water, and consolation should 


HINTS TO THE SANITARY BOARDS. 107 


be freely distributed among the poor. Soup, soap, 
flannel and smiles will do as much good as tempe- 
rance tracts and Cholera bulletins. 


“Ttis very doubtful whether Boards of Health, organized 
as they are in this country, with very limited powers, 
especially in small towns, are capable of doing much that 
is effectual towards preventing the disease; and there is 
reason to fear that they often do much injury by exciting 
alarm, which their frequent meetings are sure to create, 
and by their assurances to the public that the very first 
case of Cholera shall be announced—as if some exceedingly 
contagious disease was expected. In order to do much 
good, Boards of Health require the power to change the 
habits of the sensual, the vicious, the intemperate; and 
above all, to clothe and feed the poor, and to provide cleanly 
and comfortable dwellings for all classesin community. But 
they have not this power. The only power that exists in 
this country to stay the scourge which has ravaged Asia 
and Europe, and now threatens us, is in the possession of 
the rich. On them must fall the burden of relieving the 
wants of the suffering, and of thus preventing and mitigat- 
ing the severity of this dreaded epidemic.” —Brigham. 


/ 


XIV. 
| THE DEAD. 


Ir used to be believed, rather fancifully, that the 
bodies of those who died of Cholera underwent 
putrefaction sooner than those of persons dying un- 
der the ordinary circumstances of mortality. There 
is no evidence of any such tendency to rapid decom- 
position, and people should beware of the notion. 

In some instances the body—at least the trunk 
and head—has remained sensibly warm for some 
hours after death; and spasmodic twitchings of the 
muscles have taken place and continued for a con- 
siderable time in the corpse. Dr. Lawrie observed 
that convulsive movements were common after men- 
tal life was quite extinct; and that it was almost 
impossible to say “at what moment the vital 
motions ceased to vibrate.” A body lies appa- 
rently lifeless; suddenly a convulsive shudder 
shakes it; its hands are clenched; if you insert 
your own within them, and force them open, they 
shut again with a spasmodic catch. 

Thus, those who cling to the notion that rapid 
decomposition is peculiar to death by Cholera, are 
apt to bury with indecent haste; while those, on 
the other hand, who are ignorant and _ supersti- 
tious in regard to the fallacious warmth and the 


THE DEAD. 109 


convulsive movements, are loath to inter until the 
remains have actually begun to putrefy. 

On the 24th of July, 1832, the Special Medical 
Council of the New York Board of Health pre- 
sented a report in relation to the unnecessary haste 
with which the bodies of persons who had died of 
Cholera had, in some instances, been interred : 


“The Council,” they said, “are of opinion that the dead 
may, with perfect safety to the living, remain unburied at 
least six hours [why not twelve?], even during the present 
warm season, and, under proper precautions, for a much 
longer period. They also deem it expedient that the public 
should know that the neighborhood of the hospitals and 
burying-grounds has not been found, upon inquiry, to be 
peculiarly lable to the disease. At the public burying- 
ground, called the Potter’s Field, where nearly 100 bodies 
have been buried daily, during the past week, none of those 
engaged in the work have been taken ill; and of the 100 
persons living in the Asylum for the Deaf and Dumb, with- 
in 200 yards of the same not one is known to have been 
attacked. ” 


MORAL. 


Epidemic Cholera is a main branch of the Uni- 
versal Sanitary Commission of Almighty God; and 
of all the nuisances it is appointed to abate, that 
which insults with foulest offense the nostrils of 
the Divine Source of all physical and moral health 
and healing, is fat, lazy, selfish, imbecile ignor- 
ance or indifference. Chloride of lime will not 
heal the sores of Lazarus, nor quarantines quiet the 
consternations of Dives. 


110 THE DEAD. 


“Wealth has no power to bribe, nor Beauty to charm this 
oppressor ; 
But all perish alike beneath the scourge of his anger ; 
Only, alas! the poor, who have neither friends nor at- 
tendants, 
Creep away to die in the Alms-house, home of the home- 
less,” 


APPENDIX. 


[From the New York Tribune, Jan. 20, 1866. ] 
CHOLERA—ITS HISTORY AND LOCALIZING CAUSES. 


CHoteraA and Commerce have this much con- 
nection, that the former follows the path of the lat- 
ter, and keeps most easily along water-sides. At 
Alexandria, it began last May in a filthy suburb 
occupied by a dense crowd of Arabs, Maltese, and 
Greeks, and there strengthened itself until it killed 
two hundred a day. It also travelled to Cairo and 
other places along the Nile. It passed around the 
eastern coast of the Mediterrean, reaching Beyrout, 
Jaffa, Alexandretta, and Smyrna, and by the middle 
of July was taking a thousand lives daily in filthy 
Constantinople. The island of Malta, the province of 
Palermo, the cities of Modena, Ancona, San Paulo, 
Valentia, Toulon, Marseilles, Gibraltar, Madrid, 
Odessa, Paris, and Southampton, were reached, 
proving that the epidemic does follow water-lines. 
It travelled to Bagdad and the borders of the Per- 
sian Gulf, and to Damascus and Jerusalem. At the 
same time, Mecca and Medina, and the caravans of 
pilgrims, were most severely attacked. Out of 
700,000 pilgrims visiting Mecca in May, it is esti- 
mated that 40,000 perished by Cholera. Out of a 
single shipload of devotees from southern India, 
arriving at the Arabian port of Moculla, in Mid- 
winter, eighty died before their companions left the 
ship. And, generally, it may be remarked, that the 
relation of human agency in the transportation of 


112 APPENDIX. 


the epidemic was unusually marked, and that the 
epidemic has followed the laws: previously deduced 
from its history; that the season was exceedingly 
hot and damp; that the first and chief epidemic 
centres were by the water-sides and in the most 
humid localities, and that the epidemic earliest and 
ost fatally “‘ afflicted the persons and classes who 
dwell in foul air, and who are most negligent and 
reckless in their diet, who indulge in excesses and 
abuses of their appetites, and who are generally most 
subject to the diseases that arise from bad diet and 
the neglect of selfcare.” 

This country has had four visitations of Cholera. 
In June of 1832, it was found in an emigrant vessel 
in the St. Lawrence river; it reached Quebec a few 
days later, New York two weeks later than Quebec, 
and soon afterwards cases were found in Albany and 
other cities along the water-line of the Middle 
States. In this city, it then killed 3,513. On the 
2d of December, 1848, it again reached New York 
in the emigrant ship “‘ New York,” having killed 14 
passengers during the voyage of three weeks from 
Havre. About the same time it arrived at New 
Orleans, killing there 1,400 during January ; in a fort- 
night it was at Memphis; another fortnight carried 
it to St. Louis; and another to Nashville and Cin- 
cinnati. On the 11th of May it reappeared in 
New York, finding a home awaiting it at the Five 
Points; and during that year 5,071 deaths occurred 
in the city by it; and in the summer of 1854, it 
claimed 2,509 more. 

Dr. Snow, the Superintendent of Health of the 
city of Providence—than whom a more careful and 
efficient health officer is not to be found—in a recent 
report to the Providence Board of Health, declares 
that he ‘can point out the precise localities in the 
city where the Cholera will prevail if it visits us 


APPENDIX. 113 


again; can show the houses in which it will do its 
worst work; can name the families and almost the 
individuals who will have the disease; can show 
what there is in those localities, houses, families, 
and individuals, which will cause the disease; and 
can show that those causes might be removed, and 
the disease prevented, by the proper action of the 
authorities, of the owners of the houses, and of in- 
dividuals.” The General Board of Health of Great 
Britain declared that, as was anticipated, in 1849, 
the “Cholera returned to the same countries, and 
the same cities and towns, and even the same 
streets, and houses, and rooms, which it ravaged in 
1832;” and, furthermore, it is stated that ‘but 
very few indeed who suffered then have escaped 
now, except in those instances in which sanitary 
measures have in the mean time been effected.” 
The city of Worcester, on the Severn, which had 
twice been scourged, having performed a thorough 
cleansing, escaped the following epidemic, which 
swept the neighboring cities. The Cholera of 1849, 
with insignificant exceptions, prevailed, out of five 
hundred towns noted, in those previously known for 
their local impurities; in sixty-cight towns, where it 
raged severely, the Committee of the Royal Col- 
lege of Surgeons found the localizing causes of 
pestilence prevailing; and in fifty-one out of fifty- 
three quarters where it first appeared, in as many 
districts, the well-known and preventable causes 
were found. Thus the medical officers report that 
“in the town of Jewksbury the Cholera was first 
announced in an alley containing a slaughter-house, 
pig-styes, and a bone-deposit; and for more than a 
month it lingered there, spreading thence over the 
town. In the city of Hull it was at first limited to 
the ill-drained localities. In St. Giles’ Parish (Lon- 
don) it commenced in Church street, where the 


114 APPENDIX. 


drainage and ventilation were bad, cleaning defec- 
tive, and population dense. In Islington, malaria 
from bad drainage and ventilation was the general 
cause. In Chatham the disease was chiefly confined 
to the narrow lanes and alleys which are crowded, 
deficient in- cleanliness, and where fever is more or 
less prevalent. In Liverpool the disease was con- 
fined for the most part to the worst ventilated, low, 
and ill-drained courts. Lodging-houses of this 
character were sometimes alone attacked.” That 
class of lodging-houses in England that has been 
brought under sanitary regulations, with an aggre- 
gate population of eighty thousand, was almost to- 
tally exempt from Cholera during the last epidemics. 
The report of the General Board of Health for 
1849 states, that in the great tenant-house, called 
the Metropolitan Buildings, in which health regula- 
tions were complete, with a population of five 
hundred, not a case occurred, although the ept- 
demic was very fatal in that district. And the 
report of the same Board, in 1851, states that “in 
the Metropolis every efficient sanitary improvement 
has been followed, as directly as cause and effect, 
by a corresponding decrease of sickness and mor- 
tality. There is no exception to this rule. It 
applies to the courts, alleys, and houses occupied 
by the industrious classes; it applies to public insti- 
tutions of every kind—to prisons, to hospitals, to 
lunatic asylums, and, above all, to establishments 
specially erected to test the value of sanitary prin- 
ciples—to the model lodging-houses of the Metro- 
polis. In a report on Epidemic Cholera, it is 
shown that only one out of seven hundred and 
ninety-five persons, inmates of these model build- 
ings, had been attacked by the disease; whereas, 
among the population of London generally, one 
person in seventy-five was attacked. 


APPENDIX. 115 


CHOLERA AND COMMON SENSE. 
BY THE EMINENT DR. JACOB BIGELOW. 


Within the present century, Cholera, a disease in- 
digenous in hot climates of the East, has at various 
intervals made its appearance in the temperate lati- 
tudes of Europe and America. It is now again ex- 
citing interest from its possible, and, perhaps, proba- 
ble approach to this country. 

The experience of the last thirty or forty years 
has led a majority of medical men who had observed 
the disease, to believe that, as a general law, it is not 
contagious. In this belief [ must individually remain, 
until evidence more satisfactory than any which has 
yet appeared shall justify an opposite conviction. 

The great epidemics of 1830 and 1847 had a re- 
markable coincidence in the path which they pursued, 
and in the order and dates of their arrival in different 
cities. They seem to have followed certain great 
routes of travel, and to have avoided others equally 
frequented. According to Lesegue, they both visited 
consecutively, and in corresponding months, Tiflis, 
Astrakhan, Moscow, St. Petersburg, and Berlin. In 
1831, Cholera did not take the most frequented 
route from Berlin to Paris, but passed along the 
shores of the Baltic, crossed over to Sunderland, 
went down to London, and again crossed the chan- 
nel, and arrived in Paris about six months after its 
appearance in Berlin. A disease propagated by 
contagion of any kind would hardly have avoided 
the most fr equented thoroughfares from Berlin to 
Paris, while it occupied half a year in going round 
England. 

The epidemic now or lately prevailing in Europe 
appears to date back at least nine months, at which 
time it existed among the caravans of pilgrims visit- 
ing or returning from the city of Mecca. In the 


nv, 


f 


ae ey believe it to be, it ought to have begun, and 


\ 


Noo 


—. 


H 


116 APPENDIX. 


middle of May last it was at Alexandria and Cairo; 
in June, at Constantinople, Ancona, and Marseilles ; 
and in November, at Paris, Havre, and other Euro- 
pean cities. 

Thus it appears that Cholera has now existed in 
Europe from three to eight months, among cities 
having constant commercial intercourse with sea- 
ports of the United States, during which time thou- 
sands of passengers and tens of thousands of bales 
and packages have been landed in our maritime 
cities. If Cholera were as contagious or portable as 


perhaps finished its work, in many of our seaports 
before this time. , 
Epidemics require two things for their introduc- 


_in the inhabitants of the place visited; and second, 


j 


ra and extension. These are, first, predisposition 
| 


e arrival or presence of an existing cause. This 


fd . ° ° ° 
\__ cause in some epidemics, such as small-pox, 1s conta- 


gion. In others, it is an occult influence, not yet — 
discovered nor understood, nor known to be con- 
trolled, except in some instances, by hygienic 
agencies. No country, I believe, has succeeded in 
keeping out Cholera by quarantines, and no country, 
as far as we know, can produce it artificially or re- 
tain it after the predisposition has disappeared. In 
its own time it moves on thoroughfares where men 
are travelling, and spreads in cities where they are 
stationary, for no better reason known than that 
mankind are tts necessary food, and that where there 
are no people there can be no Cholera. But why, 
of two frequented roads or cities, it selects one and 
avoids the other, investigators have not yet been 
able to satisfy us. 

The credit of having introduced the present epi- 
demic into Europe is, by a sort of popular acclama- 
tion, assigned to the hosts of squalid devotees who 


APPENDIX. 117 


perform an annual pilgrimage to Mecca. Yet we 
are told that “‘the Cholera exists every year among 
the caravans of Mussulmans arriving at the holy 
cities,” so that their supposed mission of forward- 
ing the Cholera to Europe in most years fails to be 
performed. 

Cholera, like influenza and some other migratory 
diseases, has not always advanced from east to west. 
Of the vehicle in which it travels, or the course it 
is next to take, we know about as much as mankind 
knew of the cause of lightning before the discovery 
of electricity. Its conveyance and propagation have 
been ascribed to air, to water, to material foci, to 
electricity, to ozone, or to the want of it. Of late, 
in consequence of the vast development by the 
microscope of the existence everywhere of minute 
living organisms, it has become more common to 
ascribe the arrival of this and other like epidemics 
to certain unseen “germs,” which are called seeds, 
or ova, cryptogamic, or animaleular, according as 
the fancy of the theorist inclines him to adopt a 
vegetable or an animal nomenclature. 

But in this, as in many other cases, it is easier 
to trace an analogy, or to assume a cause, than it 
is to prevent an effect. Although inquirers have 
been indefatigable in their attempts to enlighten the 
world on the means of ridding ourselves of the pre- 
sence of the various co-tenants of our globe, yet no 
crusade has succeeded in banishing from our fields 
and houses the unwelcome swarm of mosquitoes, 
worms, grubs, and flies, which molest us with their 
annual presence, nor in suppressing the blight of 
grain, the potato-rot, or the peach-tree disease. 
Happily, some, if not most of these, have their 
periods of abatement or disappearance ; and this 
rather through the order of Providence than the 
agency of man. Cholera seems to abide in the same 


118 APPENDIX. 


category. We know little of its exciting cause, and 
not much of its prevention, except that by following 
in our personal habits the dictates of reason and 
experience we diminish both the fr equency and dan- 
ger of its occurrence. 

Whatever may be the cause or vehicle of Cholera, 
credulous and excitable persons are impatient of 
suspense, and are prone to cut a knot which they 
fail to untie. When an epidemic disease first 
appears, some coincidence is always brought to 
light which is supposed capable of accounting for 
it. The arrival of a ship, the opening of a trunk, or 
the washing of a garment, are among the most fre- 
quently accepted causes. But as these have hap- 
pened a thousand times before, and apparently under 
like circumstances, without any known results, it 
had been thought necessary by some of our late 
writers to narrow the compass of actual exposure 
down to the reception of the morbid excretions of 
one individual into the digestive canal of another. 
The first impression made by this announcement 
must, if true, be one of relief, the danger not seem- 
ing likely to happen very often. But to the possi- 
bility of such danger we can never oppose an abso- 
lute negative, so long as we persist in eating smelts 
and flounders caught. about the mouth of our drains, 
or even turnips, salads, and strawberries raised at 
Brighton. The risk, however, is so small, that most 
persons will prefer to take it, rather than ‘to deprive 
themselves of food or luxury. 

Of the many sensation tales printed and reprinted 
about Cholera, and the supposed instances of remark- 
able communication or arrestation, it is sufficient to 
say that they are frequently interesting, being fully 
as dramatic as they are probable. 

In the same regard we cannot help noticing that 
credulity, and perhaps private cupidity, have caused 


APPENDIX. 119 


much stress to be laid on the supposed preventive 
efficacy of what are called “ disinfectants ;” a mys- 
terious word, which implies a thing assumed but not 
proved to exist. We have deodorizers, such as 
chlorine, charcoal, ete., which by their combination 
render certain effluvia imperceptible to our noses. 
The narrative, then, of the physician of Malta, who 
covered certain surfaces in vessels with oil, and had 
them “ disinfected by chlorine gas,” “after which 
no new cases occurred,” is to be classed with other 
like results with which the medical press always 
abounds at the close of epidemics. 

In clean and well-regulated cities of temperate 
climate, Cholera is far from being the most formid- 
able of epidemics. A greater part of its victims are > 
the miserably poor, the worn-out, the ill-provided, , 
and the intemperate, in whom this disease only anti- 
cipates the date, but does not greatly crease the 
annual and biennial number of deaths. Its mortal- 
ity in our Northern Atlanéic cities rarely amounts 
to one per cent. of the population in a given place 
or year, so that a man may reside through an epi- 
demic in one of these cities with less risk than he 
can take a pleasure voyage to Europe. After hav- 
ing witnessed many cases of Cholera in this and 
other cities, I am further satisfied that it affords one 
of the easiest modes of exit from the world. 

People who would avoid or prevent Cholera, should 
cultivate equanimity, regularity of life and habits, 
cleanliness, salubrious exercise, temperance, and 
avoidance of all excesses. When they have done 
their duty in providing for the care of the sick, al- 
laying public panics, and abating public nuisances, 
they may safely dismiss their apprehensions. Little 
good and some harm is always done by the indis- 
creet agitation of a subject which is toa great ex- 
tent beyond our control. A single or sporadic case 


120 APPENDIX, 


of Cholera occurring in a village of a thousand 
inhabitants may attract little notice, and pass with- 
out record; but a hundred cases in a city of a 
hundred thousand inhabitants, make an aggregate 
“which generally causes some panic, though the pro- 
portion is exactly the same, and the panic equally 
unnecessary. It is possible that the supposed im- 
“munity of country districts in comparison with cities, 
may be accounted for by the fact, that in the sparse 
population of country towns, cases are less liable to 
be detected and published. 

I may be excused for repeating the following re- 
mark from among some ‘‘ Aphorisms” published by 
me about thirty years ago, when the disease was new 
and little known to us: “Should the Cholera con- 
tinue to prevail for three years throughout this 
continent, it would cease to interrupt either business 
or recreation. Mankind cannot always stand aghast, 
and the wheels of society at length would be no 
more impeded by its presence than they are now by 
the existence of consumption, of old age, or of 
drunkenness.”— Boston Medical and Surgical Jour- 
nal. 


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